Provider Demographics
NPI:1144643123
Name:MITCHEM, NATALIE (RD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MITCHEM
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:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-0225
Mailing Address - Country:US
Mailing Address - Phone:609-351-5261
Mailing Address - Fax:
Practice Address - Street 1:7300 N ROUTE 130
Practice Address - Street 2:SUITE 6 CRESCENT BUSINESS CENTER
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1541
Practice Address - Country:US
Practice Address - Phone:609-351-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered