Healthcare Provider Details

I. General information

NPI: 1104220979
Provider Name (Legal Business Name): ASHLEY CELESTE MUNRO R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 N LA CHOLLA BLVD
TUCSON AZ
85741-3535
US

IV. Provider business mailing address

7951 N PLACITA DEL CHANGO
TUCSON AZ
85704-4500
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-0404
  • Fax:
Mailing address:
  • Phone: 520-869-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1073142
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: