Provider Demographics
NPI:1912635368
Name:KONEGNI, ANGELA MEGHAN (MS, RD, CSR, LD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MEGHAN
Last Name:KONEGNI
Suffix:
Gender:F
Credentials:MS, RD, CSR, LD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MEGHAN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CSR
Mailing Address - Street 1:2915 E FERNAN CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5803
Mailing Address - Country:US
Mailing Address - Phone:925-818-9399
Mailing Address - Fax:
Practice Address - Street 1:212 S 11TH ST STE 4B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4000
Practice Address - Country:US
Practice Address - Phone:208-278-6388
Practice Address - Fax:208-601-6177
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102808133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered