Provider Demographics
NPI:1962031724
Name:JUBEH, EMMA (RD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:JUBEH
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 1:13341 ASH CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-3142
Mailing Address - Country:US
Mailing Address - Phone:708-299-9294
Mailing Address - Fax:
Practice Address - Street 1:13341 ASH CT
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-3142
Practice Address - Country:US
Practice Address - Phone:708-299-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86118992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered