Provider Demographics
NPI:1174677355
Name:GLASS, AKEMI S (RD)
Entity type:Individual
Prefix:
First Name:AKEMI
Middle Name:S
Last Name:GLASS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AKEMI
Other - Middle Name:
Other - Last Name:SATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1010 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3309
Mailing Address - Country:US
Mailing Address - Phone:480-461-2409
Mailing Address - Fax:
Practice Address - Street 1:2000 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1528
Practice Address - Country:US
Practice Address - Phone:307-532-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
841164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered