Provider Demographics
NPI:1043676943
Name:BAIER, MELISA S (RD, LD)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:S
Last Name:BAIER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ESSIE DAVISON DR
Mailing Address - Street 2:P.O. BOX 217
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-2915
Mailing Address - Country:US
Mailing Address - Phone:712-542-2176
Mailing Address - Fax:712-542-8381
Practice Address - Street 1:220 ESSIE DAVISON DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2915
Practice Address - Country:US
Practice Address - Phone:712-542-2176
Practice Address - Fax:712-542-8381
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01709133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered