Provider Demographics
NPI:1972741908
Name:ASTROM, MARY FRANCES (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:ASTROM
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WELLWORKS GROVER CENTER E144
Mailing Address - Street 2:OHIO UNIVERSITY
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:749-593-0250
Mailing Address - Fax:740-593-0170
Practice Address - Street 1:WELLWORKS GROVER CENTER E 144
Practice Address - Street 2:OHIO UNIVERSITY
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:749-593-0250
Practice Address - Fax:740-593-0170
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD4452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered