Provider Demographics
NPI:1639534415
Name:MEKELBURG, MARISSA (MS, RDN, CLT, HHP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MEKELBURG
Suffix:
Gender:F
Credentials:MS, RDN, CLT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8766
Mailing Address - Country:US
Mailing Address - Phone:970-518-2315
Mailing Address - Fax:
Practice Address - Street 1:3119 52ND AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8766
Practice Address - Country:US
Practice Address - Phone:970-518-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered