Healthcare Provider Details

I. General information

NPI: 1083284483
Provider Name (Legal Business Name): EMILY CHRISTINE SPELLMAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SW 9TH ST
ONTARIO OR
97914-2639
US

IV. Provider business mailing address

702 S FLORENCE CT
NAMPA ID
83686-6483
US

V. Phone/Fax

Practice location:
  • Phone: 541-881-7192
  • Fax:
Mailing address:
  • Phone: 925-375-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD-D-10215054
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: