Provider Demographics
NPI:1710507843
Name:KLESSE, MELANIE LYNN (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:KLESSE
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 1:108 JACKSON ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6101
Mailing Address - Country:US
Mailing Address - Phone:201-254-7953
Mailing Address - Fax:
Practice Address - Street 1:108 JACKSON ST APT 2C
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6101
Practice Address - Country:US
Practice Address - Phone:201-254-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86102875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered