Provider Demographics
NPI:1225519234
Name:EMMER, MARY BETH (RD, CD)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:EMMER
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 VILLAGE GREEN WAY UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2528
Mailing Address - Country:US
Mailing Address - Phone:262-247-1050
Mailing Address - Fax:
Practice Address - Street 1:1111 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-334-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator