Provider Demographics
NPI:1457397689
Name:AULTMAN, JANELL (RD)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:
Last Name:AULTMAN
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:35554-0001
Mailing Address - Country:US
Mailing Address - Phone:205-924-4698
Mailing Address - Fax:
Practice Address - Street 1:NORTHWEST MEDICAL CENTER
Practice Address - Street 2:1530 US HIGHWAY 43
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-7000
Practice Address - Fax:205-487-7645
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered