Provider Demographics
NPI:1366587149
Name:MCCUNE, KATHERINE ANNE (RD,MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:RD,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31194 LA BAYA DRIVE
Mailing Address - Street 2:107
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:818-517-0160
Mailing Address - Fax:
Practice Address - Street 1:31194 LA BAYA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4022
Practice Address - Country:US
Practice Address - Phone:818-517-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479422133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered