Healthcare Provider Details

I. General information

NPI: 1124584842
Provider Name (Legal Business Name): BROOKE GUNNING MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST
AUSTIN TX
78705-1121
US

IV. Provider business mailing address

7105 RYAN DR
AUSTIN TX
78757-1921
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2500
  • Fax:
Mailing address:
  • Phone: 512-633-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: