Provider Demographics
NPI:1003359001
Name:GERKEN, JONI KRISTINA (RD)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:KRISTINA
Last Name:GERKEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JONI
Other - Middle Name:KRISTINA
Other - Last Name:LUNDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2233 STATE ROUTE 86
Mailing Address - Street 2:PO BOX 471
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5644
Mailing Address - Country:US
Mailing Address - Phone:518-897-2469
Mailing Address - Fax:
Practice Address - Street 1:2233 STATE ROUTE 86
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5644
Practice Address - Country:US
Practice Address - Phone:518-897-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered