Healthcare Provider Details

I. General information

NPI: 1851871958
Provider Name (Legal Business Name): TRISHA MEGUMI NAKANO BHAGEN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CHANNING ST NE
WASHINGTON DC
20002-1028
US

IV. Provider business mailing address

302 CHANNING ST NE
WASHINGTON DC
20002-1028
US

V. Phone/Fax

Practice location:
  • Phone: 202-262-0609
  • Fax:
Mailing address:
  • Phone: 202-262-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDX4490
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: