Provider Demographics
NPI:1508544792
Name:DUNN, JOSHUA DAVID (LN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:DUNN
Suffix:
Gender:M
Credentials:LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2852
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-2852
Mailing Address - Country:US
Mailing Address - Phone:671-487-8735
Mailing Address - Fax:
Practice Address - Street 1:150 PEDRO STREET
Practice Address - Street 2:
Practice Address - City:YONA
Practice Address - State:GU
Practice Address - Zip Code:96915
Practice Address - Country:US
Practice Address - Phone:671-565-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
GUN13133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach