Provider Demographics
NPI:1619204807
Name:MELCHERT, STEPHANIE ANN (RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:MELCHERT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 S. 100TH PLAZA #2B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127
Mailing Address - Country:US
Mailing Address - Phone:308-340-1110
Mailing Address - Fax:
Practice Address - Street 1:5911 S 98TH PLZ
Practice Address - Street 2:#2B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3224
Practice Address - Country:US
Practice Address - Phone:308-340-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE946133V00000X
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program