Provider Demographics
NPI:1922415645
Name:LEE, ASHLEY JANE (RD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:JANE
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1550
Mailing Address - Country:US
Mailing Address - Phone:302-650-0179
Mailing Address - Fax:
Practice Address - Street 1:110 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1550
Practice Address - Country:US
Practice Address - Phone:302-650-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN005407OtherPA STATE LICENSURE