Provider Demographics
NPI:1174011100
Name:CITROWSKE, ASHLEY (RDN, LRD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CITROWSKE
Suffix:
Gender:F
Credentials:RDN, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4260
Mailing Address - Country:US
Mailing Address - Phone:218-556-8209
Mailing Address - Fax:
Practice Address - Street 1:801 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6099
Practice Address - Country:US
Practice Address - Phone:218-556-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered