Provider Demographics
NPI:1104657113
Name:LONIDIER, GWEN (RD, LD)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:LONIDIER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1151
Mailing Address - Country:US
Mailing Address - Phone:740-538-1420
Mailing Address - Fax:
Practice Address - Street 1:102 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1151
Practice Address - Country:US
Practice Address - Phone:740-538-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1096133V00000X
OHLD.7366133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered