Provider Demographics
NPI:1598171100
Name:POTTS, NATALIE (MS RD CD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:MS RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14623 NE NORTH WOODINVILLE WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4471
Mailing Address - Country:US
Mailing Address - Phone:425-770-6284
Mailing Address - Fax:
Practice Address - Street 1:14623 NE NORTH WOODINVILLE WAY STE 107
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4471
Practice Address - Country:US
Practice Address - Phone:425-770-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60171748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered