Provider Demographics
NPI:1326682170
Name:DUNMIRE, MYRANDA (MS, LN)
Entity Type:Individual
Prefix:
First Name:MYRANDA
Middle Name:
Last Name:DUNMIRE
Suffix:
Gender:F
Credentials:MS, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 S TENNIS LN APT 513
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2261
Mailing Address - Country:US
Mailing Address - Phone:661-400-2344
Mailing Address - Fax:
Practice Address - Street 1:4800 S TENNIS LN APT 513
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2261
Practice Address - Country:US
Practice Address - Phone:661-400-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered