Provider Demographics
NPI:1467898338
Name:BUNN, JENNIFER N (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:BUNN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GOVERNMENT CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8198
Mailing Address - Country:US
Mailing Address - Phone:252-902-2392
Mailing Address - Fax:
Practice Address - Street 1:201 GOVERNMENT CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8198
Practice Address - Country:US
Practice Address - Phone:252-902-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered