Provider Demographics
NPI:1417933714
Name:MUELLER-CUNNINGHAM, WENDY MARIE (PHD RD ETT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIE
Last Name:MUELLER-CUNNINGHAM
Suffix:
Gender:F
Credentials:PHD RD ETT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6533
Mailing Address - Country:US
Mailing Address - Phone:530-626-2990
Mailing Address - Fax:530-626-2992
Practice Address - Street 1:681 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5736
Practice Address - Country:US
Practice Address - Phone:530-626-2990
Practice Address - Fax:530-626-2992
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724107133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
724107OtherRD