MEDICARE: ASHANTI R BAKER MFCS, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86100175

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86100175	OTHER		CDR

General Provider Information

NPI Number	:	1376015651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHANTI R BAKER MFCS, RDN

Provider Business Mailing Address
First Line	:	3741 GRETCHEN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6640
Country	:	US
Telephone Number	:	512-665-4315
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 GRETCHEN CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6640
Country	:	US
Telephone Number	:	512-665-4315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	08/01/2023

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