Provider Demographics
NPI:1063883312
Name:MCNUTT, ASHLEY (RDN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W SAINT MARYS RD APT 923
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2482
Mailing Address - Country:US
Mailing Address - Phone:509-475-2888
Mailing Address - Fax:
Practice Address - Street 1:1111 W SAINT MARYS RD APT 923
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2482
Practice Address - Country:US
Practice Address - Phone:509-475-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86047334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered