MEDICARE: ASHLEY MCNUTT RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86047334	AZ

General Provider Information

NPI Number	:	1063883312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MCNUTT RDN

Provider Business Mailing Address
First Line	:	1111 W SAINT MARYS RD APT 923
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2482
Country	:	US
Telephone Number	:	509-475-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 W SAINT MARYS RD APT 923
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2482
Country	:	US
Telephone Number	:	509-475-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/13/2015

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