Provider Demographics
NPI:1912449901
Name:GONYA, SUSAN (RD, RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GONYA
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ORCHARDS RD
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4428
Mailing Address - Country:US
Mailing Address - Phone:215-901-2149
Mailing Address - Fax:
Practice Address - Street 1:31 ORCHARDS RD
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4428
Practice Address - Country:US
Practice Address - Phone:215-901-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0699133V00000X
PADN002194133V00000X
PARN596814163W00000X
NH069113-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse