Provider Demographics
NPI:1700572377
Name:ASHLINE, ROSE (RD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ASHLINE
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 1:10721 SURREY GREEN LN APT 419
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8971
Mailing Address - Country:US
Mailing Address - Phone:980-215-3853
Mailing Address - Fax:
Practice Address - Street 1:1824 E ARBORS DR STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2693
Practice Address - Country:US
Practice Address - Phone:980-580-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered