Provider Demographics
NPI:1780276360
Name:ELLINGSEN, ASHLEN
Entity type:Individual
Prefix:
First Name:ASHLEN
Middle Name:
Last Name:ELLINGSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9056 E 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3786
Mailing Address - Country:US
Mailing Address - Phone:702-493-9268
Mailing Address - Fax:
Practice Address - Street 1:8545 W WARM SPRINGS RD STE A-4159
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3676
Practice Address - Country:US
Practice Address - Phone:702-748-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered