MEDICARE: MISS EMILY DEJONG VOSS R.D.

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
2	133V00000X	Registered Dietitian	DT80618	TX

General Provider Information

NPI Number	:	1609053172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY DEJONG VOSS R.D.

Provider Business Mailing Address
First Line	:	9051 WINDING RIVER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7756
Country	:	US
Telephone Number	:	214-784-9244
Fax Number	:	325-657-5453

Provider Business Practice Location Address
First Line	:	9051 WINDING RIVER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7756
Country	:	US
Telephone Number	:	214-784-9244
Fax Number	:

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	10/04/2018

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