Provider Demographics
NPI:1669270161
Name:BANSER, EMILY (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BANSER
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:STINGL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1209 MEADOW VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2416
Mailing Address - Country:US
Mailing Address - Phone:414-379-7909
Mailing Address - Fax:
Practice Address - Street 1:2598 MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1553
Practice Address - Country:US
Practice Address - Phone:805-305-9911
Practice Address - Fax:833-264-5898
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86034502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered