Provider Demographics
NPI:1225651532
Name:BAUM, NATALIE BOSCHAN (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:BOSCHAN
Last Name:BAUM
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25693 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2169
Mailing Address - Country:US
Mailing Address - Phone:248-225-1900
Mailing Address - Fax:
Practice Address - Street 1:25693 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2169
Practice Address - Country:US
Practice Address - Phone:248-225-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86090742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered