Provider Demographics
NPI:1750992608
Name:WOJTOWICZ, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WOJTOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 WATER MILL TRL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5743
Mailing Address - Country:US
Mailing Address - Phone:520-604-8155
Mailing Address - Fax:
Practice Address - Street 1:1812 WATER MILL TRL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5743
Practice Address - Country:US
Practice Address - Phone:520-604-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-75963174N00000X
1037743133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No174N00000XOther Service ProvidersLactation Consultant, Non-RN