Provider Demographics
NPI:1477149433
Name:SCHOONENBERG, SONJA (RDN)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:SCHOONENBERG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:
Other - Last Name:YADGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:609 E NATHAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-2167
Mailing Address - Country:US
Mailing Address - Phone:720-771-3897
Mailing Address - Fax:
Practice Address - Street 1:609 E NATHAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-2167
Practice Address - Country:US
Practice Address - Phone:720-771-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCDR-837294133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
837294OtherRDN REGISTRATION NUMBER