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General NPI Number Information
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NPI Number | 1679843643
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Entity Type | Individual
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Provider Name | ASHLEY DIANE WILLSON RD, CDN, CCDES
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Gender | Female
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1783 ROUTE 9 STE 101
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City | HALFMOON
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State | NY
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Zip | 12065-2467
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Country | US
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Telephone | 518-881-1091
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Fax | 518-881-0796
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Provider Business Mailing Address
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Address Line | 6 WELLNESS WAY STE 201
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City | LATHAM
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State | NY
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Zip | 12110-2156
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Country | US
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Telephone | 518-782-3700
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Fax | 518-782-3799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 007330
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 007330-1
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License Number State | NY
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