Provider Demographics
NPI:1073156600
Name:MANDA, MELISSA (ND)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MANDA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0745
Mailing Address - Country:US
Mailing Address - Phone:316-648-1233
Mailing Address - Fax:
Practice Address - Street 1:851 COHO WAY STE 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2021
Practice Address - Country:US
Practice Address - Phone:360-746-6923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-27
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
MTAHC-NAT-LIC-1964175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath