Healthcare Provider Details

I. General information

NPI: 1497183735
Provider Name (Legal Business Name): ANGELA BARTLETT MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE SUITE 110
GLENDALE AZ
85308-8725
US

IV. Provider business mailing address

67 SARAH LN
POWNAL VT
05261-9519
US

V. Phone/Fax

Practice location:
  • Phone: 623-399-6825
  • Fax: 623-505-3474
Mailing address:
  • Phone: 518-275-6183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1098897
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1098897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: