Provider Demographics
NPI:1043530785
Name:RUBERY, MELANIE RAINWATER (MS,RD,LD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RAINWATER
Last Name:RUBERY
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 MONTGOMERY HWY
Mailing Address - Street 2:104
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-492-0404
Mailing Address - Fax:205-823-7500
Practice Address - Street 1:685 PADEN DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35226-2842
Practice Address - Country:US
Practice Address - Phone:205-492-0404
Practice Address - Fax:205-823-7500
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL851879133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered