MEDICARE: ASHLEY MARIE LYTWYN MS, RD, LDN

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	86002175	IL

General Provider Information

NPI Number	:	1770982142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIE LYTWYN MS, RD, LDN

Provider Business Mailing Address
First Line	:	2789 MADERA DR
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1823
Country	:	US
Telephone Number	:	860-810-4673
Fax Number	:	877-516-4391

Provider Business Practice Location Address
First Line	:	2789 MADERA DR
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1823
Country	:	US
Telephone Number	:	860-810-4673
Fax Number	:	877-516-4391

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	06/16/2024

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