MEDICARE: ASHLEE PAX RDN, LD

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	37002511A	IN

General Provider Information

NPI Number	:	1891445961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE PAX RDN, LD

Provider Business Mailing Address
First Line	:	1100 REID PARKWAY
Second Line	:	MEDICAL STAFF SERVICES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	659-358-8027
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	1050 REID PKWY STE 305
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1159
Country	:	US
Telephone Number	:	765-983-3423
Fax Number	:	765-983-7924

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	08/03/2022

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