Provider Demographics
NPI:1437762036
Name:FOX, NATALIE (RD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0865
Mailing Address - Country:US
Mailing Address - Phone:530-205-5605
Mailing Address - Fax:
Practice Address - Street 1:693 BOLSTERS MILLS RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:ME
Practice Address - Zip Code:04040-3806
Practice Address - Country:US
Practice Address - Phone:530-205-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered