Provider Demographics
NPI:1568172914
Name:MEYER, MARISA MICHELLE (MS, RD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:MICHELLE
Last Name:MEYER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:MICHELLE
Other - Last Name:LINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD
Mailing Address - Street 1:70 BROAD ST APT 103
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-1116
Mailing Address - Country:US
Mailing Address - Phone:317-604-7179
Mailing Address - Fax:
Practice Address - Street 1:4348 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0720
Practice Address - Country:US
Practice Address - Phone:540-240-7580
Practice Address - Fax:540-857-5391
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care