Provider Demographics
NPI:1295171064
Name:DUNAVAN, JENNIFER M (RD, LMNT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DUNAVAN
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-1951
Mailing Address - Country:US
Mailing Address - Phone:515-695-3785
Mailing Address - Fax:833-719-1241
Practice Address - Street 1:5010 O ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-1951
Practice Address - Country:US
Practice Address - Phone:402-314-6704
Practice Address - Fax:402-465-0417
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE899133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered