Provider Demographics
NPI:1053681627
Name:SWONKE, LAUREN (RD, LD)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:SWONKE
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 1:27 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-1403
Mailing Address - Country:US
Mailing Address - Phone:979-777-9132
Mailing Address - Fax:
Practice Address - Street 1:234 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-1346
Practice Address - Country:US
Practice Address - Phone:979-777-9132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82167133V00000X
OH7037133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7073OtherOHIO BOARD OF DIETETICS NUMBER