Provider Demographics
NPI:1295497568
Name:WATSON, NATASHA ALEXI (RD)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:ALEXI
Last Name:WATSON
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 1:9856 SHALLOW CREEK LOOP APT 101
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5513
Mailing Address - Country:US
Mailing Address - Phone:305-582-2359
Mailing Address - Fax:
Practice Address - Street 1:9856 SHALLOW CREEK LOOP APT 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5513
Practice Address - Country:US
Practice Address - Phone:305-582-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86117481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered