Provider Demographics
NPI:1790548899
Name:LARSEN, NATALIE RENEE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENEE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-7001
Mailing Address - Country:US
Mailing Address - Phone:847-707-6739
Mailing Address - Fax:
Practice Address - Street 1:242 S STATE ST
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-7001
Practice Address - Country:US
Practice Address - Phone:847-707-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5343-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered