Provider Demographics
NPI:1619506342
Name:PFEIFFER, MELISSA (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PFEIFFER
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 1:6040 FORD RD N
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-7305
Mailing Address - Country:US
Mailing Address - Phone:812-270-1915
Mailing Address - Fax:
Practice Address - Street 1:6040 FORD RD N
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-7305
Practice Address - Country:US
Practice Address - Phone:812-270-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered