Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4431 | OH |
NPI | 1316351257 |
---|---|
Provider Name | Dr. Ashley Nicole Marchek Vicen |
First Address | Dayton, OH 45419-3231 |
Second Address | Yellow Springs, OH 45387-1632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 12/01/2021 |