Provider Demographics
NPI:1982132916
Name:VAN ECK, EMILY MAE (MS, RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:VAN ECK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5210
Mailing Address - Country:US
Mailing Address - Phone:512-771-0315
Mailing Address - Fax:
Practice Address - Street 1:206 N CLARK ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5210
Practice Address - Country:US
Practice Address - Phone:512-771-0315
Practice Address - Fax:512-771-0315
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered