Provider Demographics
NPI:1841622727
Name:DUNEGAN, JESSILYN ROSE (RD, CSP, LD)
Entity type:Individual
Prefix:MRS
First Name:JESSILYN
Middle Name:ROSE
Last Name:DUNEGAN
Suffix:
Gender:F
Credentials:RD, CSP, LD
Other - Prefix:MS
Other - First Name:JESSILYN
Other - Middle Name:ROSE
Other - Last Name:DUNKELBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4320 DIPLOMACY DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5925
Mailing Address - Country:US
Mailing Address - Phone:907-729-8853
Mailing Address - Fax:907-729-6156
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:SUITE 2300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-8853
Practice Address - Fax:907-729-6156
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered