Provider Demographics
NPI:1720373236
Name:DORMAN, EMILY THERESA (RDN, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:THERESA
Last Name:DORMAN
Suffix:
Gender:F
Credentials:RDN, LD, CDE
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:THERESA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD, CDE
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:319-356-2692
Mailing Address - Fax:319-356-8674
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1007
Practice Address - Country:US
Practice Address - Phone:319-356-2692
Practice Address - Fax:319-356-8674
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered