Provider Demographics
NPI:1194980300
Name:HEADLEY-BUNNS, JENNIFER ANSIO (RD, LD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANSIO
Last Name:HEADLEY-BUNNS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 KETTERING DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1522
Mailing Address - Country:US
Mailing Address - Phone:301-336-6980
Mailing Address - Fax:301-808-7964
Practice Address - Street 1:411 KETTERING DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-1522
Practice Address - Country:US
Practice Address - Phone:301-336-6980
Practice Address - Fax:301-808-7964
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCD185133V00000X
MDD00768133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered