Provider Demographics
NPI:1477928885
Name:MAILAHN, NATALIE MARIE (RD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:MAILAHN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1734
Mailing Address - Country:US
Mailing Address - Phone:856-912-0032
Mailing Address - Fax:
Practice Address - Street 1:8 LOGAN DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1734
Practice Address - Country:US
Practice Address - Phone:252-638-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86008839133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86008839OtherACADEMY OF NUTRITION AND DIETETICS