Provider Demographics
NPI:1760849715
Name:CUNNINGHAM, JULIE D (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 TRELLIS LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4578
Mailing Address - Country:US
Mailing Address - Phone:828-243-7881
Mailing Address - Fax:
Practice Address - Street 1:212 S GROVE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4006
Practice Address - Country:US
Practice Address - Phone:828-243-7881
Practice Address - Fax:888-695-1187
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001617133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered