Provider Demographics
NPI:1003206822
Name:HENSZEY, MELISSA ANNE (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:HENSZEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:HENSZEY
Other - Last Name:BLEAKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1531
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1531
Mailing Address - Country:US
Mailing Address - Phone:907-707-5665
Mailing Address - Fax:
Practice Address - Street 1:2030 S KILLARNEY DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8278
Practice Address - Country:US
Practice Address - Phone:907-707-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
863658133V00000X
AK353133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered