Provider Demographics
NPI:1467634014
Name:PIEPER, MELISSA DAWN (MBA, RD, CSR)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DAWN
Last Name:PIEPER
Suffix:
Gender:F
Credentials:MBA, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12745 S. SAGINAW RD.
Mailing Address - Street 2:STE. 806-177
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2437
Mailing Address - Country:US
Mailing Address - Phone:810-923-5600
Mailing Address - Fax:810-396-6882
Practice Address - Street 1:12745 S. SAGINAW RD.
Practice Address - Street 2:STE. 806-177
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2437
Practice Address - Country:US
Practice Address - Phone:810-923-5600
Practice Address - Fax:810-396-6882
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6985001Medicare UPIN