Provider Demographics
NPI:1609681048
Name:SMITH, EMILY CHRISTINE (MS, RD, LD, CLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, RD, LD, CLC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:CHRISTINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD, CLC
Mailing Address - Street 1:351 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049-4002
Mailing Address - Country:US
Mailing Address - Phone:480-226-7422
Mailing Address - Fax:
Practice Address - Street 1:2827 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-2403
Practice Address - Country:US
Practice Address - Phone:515-695-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered