Basic Information
| Provider Information | |||||||||
| NPI: | 1629610811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUBAK | ||||||||
| FirstName: | ASHLYN | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | RDN, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3479 TURNBERRY DR | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172028141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174912355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172673000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN006934 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.