Provider Demographics
NPI:1548408354
Name:WUNDERLICH, BENJAMAN (MS, RD, LD, CSSD)
Entity type:Individual
Prefix:
First Name:BENJAMAN
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:M
Credentials:MS, RD, LD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE ROAD
Mailing Address - Street 2:TRIPLER ARMY MEDICAL CENTER
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96859
Mailing Address - Country:US
Mailing Address - Phone:808-433-2387
Mailing Address - Fax:
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:857-240-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT978297133V00000X
133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics