Provider Demographics
NPI:1609126101
Name:DUNAWAY, ALLISON RAE (RD, LD, CLT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RAE
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:RD, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DIAMOND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458
Mailing Address - Country:US
Mailing Address - Phone:937-238-4187
Mailing Address - Fax:
Practice Address - Street 1:130 DIAMOND DRIVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-238-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
846796OtherREGISTERED DIETITIAN
OH4218OtherLICENSED DIETITIAN IN THE STATE OF OHIO