Provider Demographics
NPI:1891236568
Name:KYBURZ, EMILY (RDN, CD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:KYBURZ
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 NEW VISION DR
Mailing Address - Street 2:BLDG H
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:266-266-1401
Mailing Address - Fax:260-458-5734
Practice Address - Street 1:11141 PARKVIEW PLAZA DR
Practice Address - Street 2:STE 305B
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1713
Practice Address - Country:US
Practice Address - Phone:260-425-6770
Practice Address - Fax:260-425-6789
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37002467A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered