Provider Demographics
NPI:1750131256
Name:FORTNER, EMILY (RDN, LDN, MPH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FORTNER
Suffix:
Gender:F
Credentials:RDN, LDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7444 E STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47468-9734
Mailing Address - Country:US
Mailing Address - Phone:812-215-9795
Mailing Address - Fax:
Practice Address - Street 1:2900 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-275-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86101483133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered