Provider Demographics
NPI:1972253623
Name:WYATT, EMILEE (RDN)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:EMILEE
Other - Middle Name:
Other - Last Name:ASCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:209 E SILVER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1813
Mailing Address - Country:US
Mailing Address - Phone:402-370-0033
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09708133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered