Provider Demographics
NPI:1619506409
Name:DIERSING, MELISSA JEAN (RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:DIERSING
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6294 ALERT NEW LONDON RD
Mailing Address - Street 2:
Mailing Address - City:OKEANA
Mailing Address - State:OH
Mailing Address - Zip Code:45053-9691
Mailing Address - Country:US
Mailing Address - Phone:513-484-7740
Mailing Address - Fax:
Practice Address - Street 1:6294 ALERT NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:OKEANA
Practice Address - State:OH
Practice Address - Zip Code:45053-9691
Practice Address - Country:US
Practice Address - Phone:513-484-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001212A133V00000X, 133VN1005X
OHLD3896133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal