Provider Demographics
NPI:1124661442
Name:DIRKES, EMILY (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIRKES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:BUSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:350 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:BROWERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56438-5155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:712 S CASCADE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2913
Practice Address - Country:US
Practice Address - Phone:218-736-8059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered