Basic Information
| Provider Information | |||||||||
| NPI: | 1104345495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEALY | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 PINE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685163389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024898888 | ||||||||
| FaxNumber: | 4024211945 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 PINE LAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685163389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024898888 | ||||||||
| FaxNumber: | 4024211945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 1325 | NE | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 363LF0000X | 112332 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.