Provider Demographics
NPI:1407613581
Name:BIBERSTINE, EMMA EDITH (RDN)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:EDITH
Last Name:BIBERSTINE
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 1:4303 AINOHA DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-5812
Mailing Address - Country:US
Mailing Address - Phone:956-463-6817
Mailing Address - Fax:
Practice Address - Street 1:4303 AINOHA DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5812
Practice Address - Country:US
Practice Address - Phone:956-463-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86116263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered