Provider Demographics
NPI:1215634084
Name:NUNN, LEE JAMES (MS, RD, LD)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:JAMES
Last Name:NUNN
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 BURNET RD APT 1352
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4590
Mailing Address - Country:US
Mailing Address - Phone:512-413-8377
Mailing Address - Fax:
Practice Address - Street 1:10301 BURNET RD APT 1352
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4590
Practice Address - Country:US
Practice Address - Phone:512-413-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered