Provider Demographics
NPI:1952607400
Name:NUNN, SUZANNE JEAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:JEAN
Last Name:NUNN
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:P.O. BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-2037
Mailing Address - Fax:907-842-2039
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:DILLLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576-0130
Practice Address - Country:US
Practice Address - Phone:907-842-2037
Practice Address - Fax:907-842-2039
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLICENSE-184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered