Provider Demographics
NPI:1497183735
Name:BARTLETT, ANGELA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SARAH LN
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9519
Mailing Address - Country:US
Mailing Address - Phone:518-275-6183
Mailing Address - Fax:
Practice Address - Street 1:17505 N 79TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8725
Practice Address - Country:US
Practice Address - Phone:623-399-6825
Practice Address - Fax:623-505-3474
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1098897133V00000X
AZ1098897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered