Provider Demographics
NPI:1942665146
Name:BUNNAG, RAINA GOLDSTEIN (MPH, RD, LDN)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:GOLDSTEIN
Last Name:BUNNAG
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 ENGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4221
Mailing Address - Country:US
Mailing Address - Phone:301-602-6893
Mailing Address - Fax:
Practice Address - Street 1:512 BRICKHAVEN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1492
Practice Address - Country:US
Practice Address - Phone:301-602-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004562133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered