Provider Demographics
NPI:1942965744
Name:WADLEY, ASHLYN MICHELE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:MICHELE
Last Name:WADLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:ASHLYN
Other - Middle Name:MICHELE
Other - Last Name:MARLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2210 PLYMOUTH RD APT 113
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2342
Mailing Address - Country:US
Mailing Address - Phone:612-432-5097
Mailing Address - Fax:
Practice Address - Street 1:7117 OHMS LN
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2142
Practice Address - Country:US
Practice Address - Phone:952-999-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered