Provider Demographics
NPI:1093323636
Name:MILLS, NATASHA LYN
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYN
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0936
Mailing Address - Country:US
Mailing Address - Phone:208-417-4302
Mailing Address - Fax:
Practice Address - Street 1:1600 W ANTELOPE DR BLDG ROOM
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1120
Practice Address - Country:US
Practice Address - Phone:801-807-7360
Practice Address - Fax:801-807-7363
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11703303-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11703303-4901OtherDOPL