Basic Information
| Provider Information | |||||||||
| NPI: | 1306241815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLA | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3482 | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838773482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082096170 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8500 N ATLAS RD | ||||||||
| Address2: | |||||||||
| City: | HAYDEN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838358332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084155293 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2014 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | D838 | ID | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.