Basic Information
| Provider Information | |||||||||
| NPI: | 1609488626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNNEWITH | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | RD, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024922523 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 JOSLIN PL | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173092400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 5053 | MA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.