Provider Demographics
NPI:1861091696
Name:SPONSELLER, EMMA C (RDLD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:C
Last Name:SPONSELLER
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:C
Other - Last Name:REGULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 E PALMER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2281
Mailing Address - Country:US
Mailing Address - Phone:937-651-6735
Mailing Address - Fax:
Practice Address - Street 1:205 E PALMER RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2281
Practice Address - Country:US
Practice Address - Phone:937-651-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08724133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered