Provider Demographics
NPI:1568000859
Name:ZILL, NATASHA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:ZILL
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 1:5028 BROOKFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-9362
Mailing Address - Country:US
Mailing Address - Phone:920-901-2033
Mailing Address - Fax:
Practice Address - Street 1:5028 BROOKFIELD CIR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-9362
Practice Address - Country:US
Practice Address - Phone:920-901-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered