Provider Demographics
NPI:1518789239
Name:WERNER, ASHLEY R (RD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:WERNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 FOX RUN BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-6500
Mailing Address - Country:US
Mailing Address - Phone:608-354-4928
Mailing Address - Fax:
Practice Address - Street 1:N64W24050 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3000
Practice Address - Country:US
Practice Address - Phone:608-354-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86293096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered