Provider Demographics
NPI:1750945655
Name:WUEBKER, NATASHA MARIE (RD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:WUEBKER
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 1:6200 PFEIFFER RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5862
Mailing Address - Country:US
Mailing Address - Phone:513-862-4957
Mailing Address - Fax:513-862-4952
Practice Address - Street 1:6200 PFEIFFER RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5862
Practice Address - Country:US
Practice Address - Phone:513-862-4957
Practice Address - Fax:513-862-4952
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered