Provider Demographics
NPI:1487811790
Name:VANDER WEEL, ASHLEY (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:VANDER WEEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 N PEART RD
Mailing Address - Street 2:APT 325
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:248-909-2648
Mailing Address - Fax:
Practice Address - Street 1:351 N PEART RD
Practice Address - Street 2:APT 325
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:248-909-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI961149133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered