Healthcare Provider Details

I. General information

NPI: 1114011541
Provider Name (Legal Business Name): ASHLEY BREMER RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E. INDIAN SCHOOL ROAD ACS 11C-7
PHOENIX AZ
85012
US

IV. Provider business mailing address

9003 S. 10TH DR.
PHOENIX AZ
85041
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-374-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: