Provider Demographics
NPI:1356018287
Name:LEWIS, MELANIE W (RD, LDN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E OHIO ST APT 1525
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3233
Mailing Address - Country:US
Mailing Address - Phone:814-227-9547
Mailing Address - Fax:
Practice Address - Street 1:211 E OHIO ST APT 1525
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3233
Practice Address - Country:US
Practice Address - Phone:814-227-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008481133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered