Provider Demographics
NPI:1376015651
Name:BAKER, ASHANTI R (MFCS, RDN)
Entity Type:Individual
Prefix:
First Name:ASHANTI
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:MFCS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 GRETCHEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6640
Mailing Address - Country:US
Mailing Address - Phone:512-665-4315
Mailing Address - Fax:
Practice Address - Street 1:3741 GRETCHEN CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6640
Practice Address - Country:US
Practice Address - Phone:512-665-4315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86100175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86100175OtherCDR