Provider Demographics
NPI:1821876350
Name:WATHA, NATALIE TAWA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:TAWA
Last Name:WATHA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 CAMBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4101
Mailing Address - Country:US
Mailing Address - Phone:248-914-7242
Mailing Address - Fax:
Practice Address - Street 1:5330 CAMBOURNE PL
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4101
Practice Address - Country:US
Practice Address - Phone:248-914-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered