Healthcare Provider Details

I. General information

NPI: 1417562497
Provider Name (Legal Business Name): MEGAN TOIVONEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 4660
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

2725 AGUA FRIA ST APT D103
SANTA FE NM
87507-5520
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax:
Mailing address:
  • Phone: 920-858-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberNDP-2025-0052
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: