Provider Demographics
NPI:1114761772
Name:PUNO, DANIELLE (MED, NC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PUNO
Suffix:
Gender:F
Credentials:MED, NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AGNES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6306
Mailing Address - Country:US
Mailing Address - Phone:615-538-0755
Mailing Address - Fax:
Practice Address - Street 1:1806 WILLIAMSON CT STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7974
Practice Address - Country:US
Practice Address - Phone:615-538-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education