Healthcare Provider Details

I. General information

NPI: 1114761772
Provider Name (Legal Business Name): DANIELLE PUNO M.ED., NC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 WILLIAMSON CT STE 120
BRENTWOOD TN
37027-7974
US

IV. Provider business mailing address

116 AGNES RD STE 100
KNOXVILLE TN
37919-6306
US

V. Phone/Fax

Practice location:
  • Phone: 615-538-0755
  • Fax:
Mailing address:
  • Phone: 615-538-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: