Provider Demographics
NPI:1750177697
Name:WERNER, EMILY NICOLE (PHD, RD, CSSD, IFNCP)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:NICOLE
Last Name:WERNER
Suffix:
Gender:
Credentials:PHD, RD, CSSD, IFNCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N 5TH ST APT 619
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-3662
Mailing Address - Country:US
Mailing Address - Phone:734-972-6578
Mailing Address - Fax:
Practice Address - Street 1:3 BANNER WAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1166
Practice Address - Country:US
Practice Address - Phone:734-972-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered