Healthcare Provider Details

I. General information

NPI: 1750992608
Provider Name (Legal Business Name): EMILY WOJTOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 WATER MILL TRL
KNOXVILLE TN
37922-5743
US

IV. Provider business mailing address

1812 WATER MILL TRL
KNOXVILLE TN
37922-5743
US

V. Phone/Fax

Practice location:
  • Phone: 520-604-8155
  • Fax:
Mailing address:
  • Phone: 520-604-8155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-75963
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1037743
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: