Healthcare Provider Details

I. General information

NPI: 1750945655
Provider Name (Legal Business Name): NATASHA MARIE WUEBKER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 PFEIFFER RD
MONTGOMERY OH
45242-5862
US

IV. Provider business mailing address

6200 PFEIFFER RD
MONTGOMERY OH
45242-5862
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-4957
  • Fax: 513-862-4952
Mailing address:
  • Phone: 513-862-4957
  • Fax: 513-862-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.08280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: