Provider Demographics
NPI:1164732228
Name:ASHCRAFT-PFARR, JEAN ELLEN (RDN, LN)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ELLEN
Last Name:ASHCRAFT-PFARR
Suffix:
Gender:F
Credentials:RDN, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 BROKEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4146 BROKEN HILL RD
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3956
Practice Address - Country:US
Practice Address - Phone:775-623-3605
Practice Address - Fax:775-623-3956
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL705874133V00000X
SD0036133V00000X
NV31978DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP50457Medicare UPIN