Basic Information
Provider Information
NPI: 1689066268
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNN
FirstName: KAREN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RD LD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 18101 LORAIN AVE
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441115612
CountryCode: US
TelephoneNumber: 2164767000
FaxNumber: 2164799623
Practice Location
Address1: 18101 LORAIN AVE
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441115612
CountryCode: US
TelephoneNumber: 2164767000
FaxNumber: 2164799623
Other Information
ProviderEnumerationDate: 02/19/2015
LastUpdateDate: 02/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XLD 3340OHY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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