Provider Demographics
NPI:1902655343
Name:HINTZ, EMILY ROSE (RDN, CD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:HINTZ
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 136TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5694
Mailing Address - Country:US
Mailing Address - Phone:715-703-9593
Mailing Address - Fax:
Practice Address - Street 1:4095 136TH ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5694
Practice Address - Country:US
Practice Address - Phone:715-703-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5622-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered