Provider Demographics
NPI:1598930034
Name:MARTIN, MELISSA ROOT (LDN, RD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROOT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LDN, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 RHAPSODY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4840
Mailing Address - Country:US
Mailing Address - Phone:225-924-8428
Mailing Address - Fax:
Practice Address - Street 1:10116 RHAPSODY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4840
Practice Address - Country:US
Practice Address - Phone:225-924-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered