Provider Demographics
NPI:1790534840
Name:CHURCH, ASHLIE MARIE (CNS)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:MARIE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 CHESTON LN APT G
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1935
Mailing Address - Country:US
Mailing Address - Phone:443-924-3160
Mailing Address - Fax:
Practice Address - Street 1:4 TAFT CT STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5577
Practice Address - Country:US
Practice Address - Phone:240-406-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6678133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist