Provider Demographics
NPI:1407465586
Name:YOUNG, EMILEE WELLS (RDN)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:WELLS
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S WISE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1869
Mailing Address - Country:US
Mailing Address - Phone:540-874-4493
Mailing Address - Fax:
Practice Address - Street 1:104 S WISE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1869
Practice Address - Country:US
Practice Address - Phone:540-874-4493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4918133V00000X
VA86109716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered