Provider Demographics
NPI:1558609347
Name:WOODWARD, MELISSA GRACE (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GRACE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 SOUTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2775
Mailing Address - Country:US
Mailing Address - Phone:724-850-3142
Mailing Address - Fax:724-850-3143
Practice Address - Street 1:530 SOUTH ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-850-3142
Practice Address - Fax:724-850-3143
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered