Provider Demographics
NPI:1578870762
Name:WADE, MELISSA E (MPH, RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:E
Last Name:WADE
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BLUE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-5203
Mailing Address - Country:US
Mailing Address - Phone:618-531-5710
Mailing Address - Fax:
Practice Address - Street 1:68 BLUE BIRCH DR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-5203
Practice Address - Country:US
Practice Address - Phone:618-531-5710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered