Healthcare Provider Details

I. General information

NPI: 1902710106
Provider Name (Legal Business Name): EMILY ANNE NOTARO MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COLE GRAY BLVD APT A
ELIZABETHTOWN KY
42701-2273
US

IV. Provider business mailing address

201 COLE GRAY BLVD APT A
ELIZABETHTOWN KY
42701-2273
US

V. Phone/Fax

Practice location:
  • Phone: 219-263-6712
  • Fax:
Mailing address:
  • Phone: 219-263-6712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86415118
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: