Provider Demographics
NPI:1922471952
Name:TIMM, EMILY (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TIMM
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BOSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:5140 LIBERTY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2215
Mailing Address - Country:US
Mailing Address - Phone:412-578-1724
Mailing Address - Fax:412-578-4214
Practice Address - Street 1:5140 LIBERTY AVE FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2215
Practice Address - Country:US
Practice Address - Phone:412-578-1724
Practice Address - Fax:412-578-4214
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103320329Medicaid