Provider Demographics
NPI:1730166166
Name:DUNHAM, KILEE LYNN (RD LD)
Entity type:Individual
Prefix:
First Name:KILEE
Middle Name:LYNN
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:KILEE
Other - Middle Name:LYNN
Other - Last Name:STICELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-0362
Mailing Address - Fax:319-356-8674
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-0362
Practice Address - Fax:319-356-8674
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01676133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16519Medicare PIN
Q56899Medicare UPIN