Provider Demographics
NPI:1578364725
Name:NAVESTAD, NATALIE DIANE (MS, RD, CD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:DIANE
Last Name:NAVESTAD
Suffix:
Gender:
Credentials:MS, RD, CD
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:DIANE
Other - Last Name:KERRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CD
Mailing Address - Street 1:132 N 475 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3222
Mailing Address - Country:US
Mailing Address - Phone:570-472-7579
Mailing Address - Fax:
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86326198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered