Provider Demographics
NPI:1689039943
Name:LONGOBARDI, MEGAN RAE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RAE
Last Name:LONGOBARDI
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 1:1503 NE WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-7434
Mailing Address - Country:US
Mailing Address - Phone:330-883-1578
Mailing Address - Fax:
Practice Address - Street 1:1503 NE WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-7434
Practice Address - Country:US
Practice Address - Phone:330-883-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072429133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered