Provider Demographics
NPI:1609209535
Name:VICARI-WARNER, MELODY A (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:A
Last Name:VICARI-WARNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:A
Other - Last Name:VICARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:3100 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0436
Practice Address - Country:US
Practice Address - Phone:702-255-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1042066133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1042066OtherREGISTRATION NUMBER THROUGH THE COMMISSION ON DIETETIC REGISTRATION