Provider Demographics
NPI:1083110720
Name:DUKQUITS, MELISSA KATE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATE
Last Name:DUKQUITS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SAVANNAH AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4801
Mailing Address - Country:US
Mailing Address - Phone:912-243-9200
Mailing Address - Fax:912-243-9207
Practice Address - Street 1:116 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4801
Practice Address - Country:US
Practice Address - Phone:912-243-9200
Practice Address - Fax:912-243-9207
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004646133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic