Provider Demographics
NPI:1912761107
Name:NEWELL, EMMYLOU T (RDN)
Entity Type:Individual
Prefix:
First Name:EMMYLOU
Middle Name:T
Last Name:NEWELL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:EMMYLOU
Other - Middle Name:
Other - Last Name:TEITZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23416 E DESMET CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9686
Mailing Address - Country:US
Mailing Address - Phone:509-385-9795
Mailing Address - Fax:
Practice Address - Street 1:23416 E DESMET CT
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9686
Practice Address - Country:US
Practice Address - Phone:509-385-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered