Provider Demographics
NPI:1578214961
Name:TUNBERG, JULIET
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:TUNBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E DUNBAR LN APT 1-223
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3164
Mailing Address - Country:US
Mailing Address - Phone:218-689-4664
Mailing Address - Fax:
Practice Address - Street 1:88 E DUNBAR LN APT 1-223
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3164
Practice Address - Country:US
Practice Address - Phone:218-689-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer