Provider Demographics
NPI:1851871958
Name:BHAGEN, TRISHA MEGUMI NAKANO (CNS)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:MEGUMI NAKANO
Last Name:BHAGEN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CHANNING ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1028
Mailing Address - Country:US
Mailing Address - Phone:202-262-0609
Mailing Address - Fax:
Practice Address - Street 1:302 CHANNING ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1028
Practice Address - Country:US
Practice Address - Phone:202-262-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4490133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education