Provider Demographics
NPI:1184237919
Name:BACKES, EMMA M (RDN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:BACKES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32006 NORTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-9517
Mailing Address - Country:US
Mailing Address - Phone:320-309-8913
Mailing Address - Fax:
Practice Address - Street 1:32006 NORTHWOOD LN
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-9517
Practice Address - Country:US
Practice Address - Phone:320-309-8913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4543133V00000X
MN86153210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered