Provider Demographics
NPI:1720709819
Name:PRESTON, EMILY RAE (RDN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 FORT MISSOULA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7403
Mailing Address - Country:US
Mailing Address - Phone:406-721-5566
Mailing Address - Fax:
Practice Address - Street 1:2825 FORT MISSOULA RD STE 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7403
Practice Address - Country:US
Practice Address - Phone:406-721-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MTMED-NUTR-LIC-114970133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered