Provider Demographics
NPI:1851122980
Name:HETZEL, EMILY (RD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HETZEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:TAHOMA
Mailing Address - State:CA
Mailing Address - Zip Code:96142-0786
Mailing Address - Country:US
Mailing Address - Phone:530-386-3614
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 786
Practice Address - Street 2:
Practice Address - City:TAHOMA
Practice Address - State:CA
Practice Address - Zip Code:96142-0786
Practice Address - Country:US
Practice Address - Phone:530-386-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86084383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered