Provider Demographics
NPI:1942677372
Name:PETERS, ASHLEY (MBA, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MBA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2334
Mailing Address - Country:US
Mailing Address - Phone:217-337-4520
Mailing Address - Fax:217-337-2726
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-4520
Practice Address - Fax:217-337-2726
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164006404133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered