Provider Demographics
NPI:1730487752
Name:KOVAR, GENNA MARIE (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:GENNA
Middle Name:MARIE
Last Name:KOVAR
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 1:8515 TANGLEWOOD SQ
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6460
Mailing Address - Country:US
Mailing Address - Phone:440-543-5144
Mailing Address - Fax:
Practice Address - Street 1:8515 TANGLEWOOD SQ
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-6460
Practice Address - Country:US
Practice Address - Phone:440-543-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH133VN1006X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered