Provider Demographics
NPI:1164065876
Name:SCHULTZ, NATASHA (CWP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6048 245TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-8822
Mailing Address - Country:US
Mailing Address - Phone:262-960-5021
Mailing Address - Fax:
Practice Address - Street 1:615 W MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2462
Practice Address - Country:US
Practice Address - Phone:262-896-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINONE133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education