Provider Demographics
NPI:1083342158
Name:SWENA, EMALEE JO (RDN)
Entity Type:Individual
Prefix:
First Name:EMALEE
Middle Name:JO
Last Name:SWENA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:EMALEE
Other - Middle Name:JO
Other - Last Name:BALLWEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1983
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49422-1983
Mailing Address - Country:US
Mailing Address - Phone:518-538-3979
Mailing Address - Fax:
Practice Address - Street 1:411 STRATFORD WAY APT 14
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:518-538-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered