Provider Demographics
NPI:1083193742
Name:ASHLEY REAVER NUTRITION LLC
Entity Type:Organization
Organization Name:ASHLEY REAVER NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:240-674-0948
Mailing Address - Street 1:331 LINDBERGH AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4849
Mailing Address - Country:US
Mailing Address - Phone:240-674-0948
Mailing Address - Fax:
Practice Address - Street 1:331 LINDBERGH AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4849
Practice Address - Country:US
Practice Address - Phone:240-674-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4421133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1871070805OtherINDIVIDUAL NPI