MEDICARE: DALE DIETITIANS LLC

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

General Provider Information

NPI Number	:	1538892195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE DIETITIANS LLC

Provider Business Mailing Address
First Line	:	9056 E 50TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3786
Country	:	US
Telephone Number	:	702-493-9268
Fax Number	:

Provider Business Practice Location Address
First Line	:	8545 W WARM SPRINGS RD STE A-4159
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3676
Country	:	US
Telephone Number	:	702-748-9311
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN NUTRITIONIST
Name	:	MRS. ASHLEN ELLINGSEN
Credential	:	RDN
Telephone Number	:	702-493-9268

Provider Enumeration Date	:	07/01/2022
Last Update Date	:	07/25/2022

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