Provider Demographics
NPI:1902824352
Name:EMERSON, DAYNA (RD, CDE)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:
Last Name:EMERSON
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 1:905 UNION ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3050
Mailing Address - Country:US
Mailing Address - Phone:207-973-7334
Mailing Address - Fax:207-973-7424
Practice Address - Street 1:905 UNION ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3050
Practice Address - Country:US
Practice Address - Phone:207-973-7334
Practice Address - Fax:207-973-7424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1757133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT0190Medicare ID - Type Unspecified