Provider Demographics
NPI:1144946716
Name:WILSON, NATALIE (RD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:WILSON
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 1:3531 AUGUSTA CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2968
Mailing Address - Country:US
Mailing Address - Phone:707-688-5859
Mailing Address - Fax:
Practice Address - Street 1:1443 MAIN ST STE 130B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1939
Practice Address - Country:US
Practice Address - Phone:707-200-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered