Provider Demographics
NPI:1730604513
Name:LYBBERT, EMILY KRUEGER (RDN, MS, CSOWM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KRUEGER
Last Name:LYBBERT
Suffix:
Gender:F
Credentials:RDN, MS, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 WALDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6811
Mailing Address - Country:US
Mailing Address - Phone:910-723-4559
Mailing Address - Fax:
Practice Address - Street 1:5045 WALDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6811
Practice Address - Country:US
Practice Address - Phone:910-723-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006221133V00000X
UT9893745-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered