Provider Demographics
NPI:1437334059
Name:NIESCHBURG, EMILY C (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:C
Last Name:NIESCHBURG
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-3939
Mailing Address - Country:US
Mailing Address - Phone:719-336-4343
Mailing Address - Fax:719-336-7207
Practice Address - Street 1:401 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3942
Practice Address - Country:US
Practice Address - Phone:719-336-4343
Practice Address - Fax:719-336-7207
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO950782133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered