Provider Demographics
NPI:1407515802
Name:LUONGO, ANNE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:LUONGO
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 WESTFIELD CT W APT I
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1164
Mailing Address - Country:US
Mailing Address - Phone:908-358-2673
Mailing Address - Fax:
Practice Address - Street 1:1101 E BAYAUD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2458
Practice Address - Country:US
Practice Address - Phone:908-358-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2024-03-15
Deactivation Date:2021-12-27
Deactivation Code:
Reactivation Date:2023-03-27
Provider Licenses
StateLicense IDTaxonomies
IN37003346A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered