Provider Demographics
NPI:1053158626
Name:THILAVONG, JONI (RDN)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:THILAVONG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 HELMBRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3258
Mailing Address - Country:US
Mailing Address - Phone:614-657-6849
Mailing Address - Fax:
Practice Address - Street 1:229 HELMBRIGHT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-3258
Practice Address - Country:US
Practice Address - Phone:614-657-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5263133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal