Provider Demographics
NPI:1417497363
Name:ULRICH, ANNSLEY KENNERLY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ANNSLEY
Middle Name:KENNERLY
Last Name:ULRICH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FERNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4403
Mailing Address - Country:US
Mailing Address - Phone:704-883-2606
Mailing Address - Fax:
Practice Address - Street 1:145 FERNBROOK DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4403
Practice Address - Country:US
Practice Address - Phone:704-883-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001246133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered