Individual
EMILY REBECCA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CD, CSO
Contact information
Practice address
1515 PARK AVE, COLUMBUS, WI 53925-1618
(920) 350-2672
(920) 623-1250
Mailing address
1515 PARK AVE, COLUMBUS, WI 53925-1618
(920) 350-2672
(920) 623-1250
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
253129
WI
Other
Enumeration date
12/17/2012
Last updated
11/30/2023
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