Provider Demographics
NPI:1346543121
Name:WENTWORTH, ASHLEY LYNN (RD/LD)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:LYNN
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:CANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:170 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3556
Mailing Address - Country:US
Mailing Address - Phone:603-788-2521
Mailing Address - Fax:603-788-5027
Practice Address - Street 1:173 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3508
Practice Address - Country:US
Practice Address - Phone:603-788-2521
Practice Address - Fax:603-788-5027
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1001491133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered