Provider Demographics
NPI:1659098655
Name:NOVAK, ASHLEY (NTP, RWS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NOVAK
Suffix:
Gender:F
Credentials:NTP, RWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 IVANHOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2628
Mailing Address - Country:US
Mailing Address - Phone:708-305-1767
Mailing Address - Fax:
Practice Address - Street 1:138 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-5105
Practice Address - Country:US
Practice Address - Phone:708-305-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6197133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist