Provider Demographics
NPI:1497536510
Name:NYSTROM, MELANIE POWERS (MA, NBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:POWERS
Last Name:NYSTROM
Suffix:
Gender:F
Credentials:MA, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 JOSIE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7160
Mailing Address - Country:US
Mailing Address - Phone:410-591-3286
Mailing Address - Fax:
Practice Address - Street 1:5423 JOSIE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-7160
Practice Address - Country:US
Practice Address - Phone:410-591-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA-3814236171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach