Provider Demographics
NPI:1386991891
Name:MARTIN, NATALIE RAE (MS, RD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 E STATE ROAD 234
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9027
Mailing Address - Country:US
Mailing Address - Phone:317-753-6120
Mailing Address - Fax:
Practice Address - Street 1:3220 E STATE ROAD 234
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-9027
Practice Address - Country:US
Practice Address - Phone:317-753-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
TX14755171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist