Provider Demographics
NPI:1376785873
Name:MORRIS, MELISSA SUZANNE (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUZANNE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1143
Mailing Address - Country:US
Mailing Address - Phone:805-458-5222
Mailing Address - Fax:
Practice Address - Street 1:2719A MEADOW CREEK WAY
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-1608
Practice Address - Country:US
Practice Address - Phone:805-458-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA992995133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist