Provider Demographics
NPI:1114542362
Name:PAINTER, ASHLEY AMELIA (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMELIA
Last Name:PAINTER
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 1:1250 W GLENOAKS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2281
Mailing Address - Country:US
Mailing Address - Phone:801-691-2812
Mailing Address - Fax:
Practice Address - Street 1:1250 W GLENOAKS BLVD STE E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-2281
Practice Address - Country:US
Practice Address - Phone:801-691-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86114107OtherCOMMISSION OF DIETETIC REGISTRATION