Provider Demographics
NPI:1396363131
Name:BRATKO, NATHAN (CNS LDN)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BRATKO
Suffix:
Gender:M
Credentials:CNS LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29339 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4853
Mailing Address - Country:US
Mailing Address - Phone:201-956-3952
Mailing Address - Fax:
Practice Address - Street 1:606 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3305
Practice Address - Country:US
Practice Address - Phone:410-763-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3765133NN1002X, 133VN1004X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist