Provider Demographics
NPI:1134467459
Name:SARVER, MALISSA (MS,RDN,LD,CDE)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:
Last Name:SARVER
Suffix:
Gender:F
Credentials:MS,RDN,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4104
Mailing Address - Country:US
Mailing Address - Phone:740-354-5648
Mailing Address - Fax:
Practice Address - Street 1:919 7TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4104
Practice Address - Country:US
Practice Address - Phone:740-821-0863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1954133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered