Healthcare Provider Details

I. General information

NPI: 1114319696
Provider Name (Legal Business Name): KAREN NATHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST C-10
PRINCETON NJ
08540-2757
US

IV. Provider business mailing address

601 EWING ST C-10
PRINCETON NJ
08540-2757
US

V. Phone/Fax

Practice location:
  • Phone: 609-577-7096
  • Fax:
Mailing address:
  • Phone: 609-577-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberW45695
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberW45695
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberW45695
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: