Provider Demographics
NPI:1003367673
Name:BEASLEY, MELANIE (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:461 STONEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-2503
Mailing Address - Country:US
Mailing Address - Phone:952-484-1137
Mailing Address - Fax:
Practice Address - Street 1:461 STONEWOOD LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-2503
Practice Address - Country:US
Practice Address - Phone:952-484-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered