Provider Demographics
NPI:1184911141
Name:FONEBI, GWENDOLINE (MD)
Entity type:Individual
Prefix:
First Name:GWENDOLINE
Middle Name:
Last Name:FONEBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4168
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4168
Mailing Address - Country:US
Mailing Address - Phone:208-239-1035
Mailing Address - Fax:208-239-3626
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5147
Practice Address - Country:US
Practice Address - Phone:208-239-1720
Practice Address - Fax:208-239-1726
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2061778207R00000X, 207RX0202X
NC2018-02128207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine