MEDICARE: EMILY MAE VAN ECK MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2798	LA
2	133V00000X	Registered Dietitian	DT86052	TX

General Provider Information

NPI Number	:	1982132916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MAE VAN ECK MS, RD

Provider Business Mailing Address
First Line	:	4514 AVENUE B UNIT 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3022
Country	:	US
Telephone Number	:	512-771-0315
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 AVENUE B UNIT 2
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-3022
Country	:	US
Telephone Number	:	512-771-0315
Fax Number	:	512-771-0315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2017
Last Update Date	:	03/06/2026

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