Provider Demographics
NPI:1366232472
Name:PRODANOVICH, NATALIE (RD/RDN, LD/LDN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:PRODANOVICH
Suffix:
Gender:X
Credentials:RD/RDN, LD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 GREEN LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3446
Mailing Address - Country:US
Mailing Address - Phone:901-848-8433
Mailing Address - Fax:901-848-8433
Practice Address - Street 1:7691 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3904
Practice Address - Country:US
Practice Address - Phone:901-516-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered