Healthcare Provider Details

I. General information

NPI: 1770194615
Provider Name (Legal Business Name): LAUREN ASHLEY DUDA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 W BEVERLY LN
GLENDALE AZ
85306-1800
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 623-312-3000
  • Fax: 623-312-3060
Mailing address:
  • Phone: 480-245-6286
  • Fax: 480-398-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86174174
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: