Provider Demographics
NPI:1346021797
Name:ELLIOTT, EMILY (RDN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:STOCKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1425 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3105
Practice Address - Country:US
Practice Address - Phone:616-644-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86109329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered