Provider Demographics
NPI:1427597533
Name:FISH, EMILY (RDN, CD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WISECUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, CD
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 112TH AVE NE BLDG 4
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:425-289-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60725624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered