Provider Demographics
NPI:1972316222
Name:TEWKSBURY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:TEWKSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 CHURCH AND STATE WAY APT 404
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3998
Mailing Address - Country:US
Mailing Address - Phone:440-708-4027
Mailing Address - Fax:
Practice Address - Street 1:1433 CHURCH AND STATE WAY APT 404
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3998
Practice Address - Country:US
Practice Address - Phone:440-708-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86176446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered