Provider Demographics
NPI:1710567268
Name:MESSMORE, MARILYN (CNS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MESSMORE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 ABISSO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2572
Mailing Address - Country:US
Mailing Address - Phone:702-716-2098
Mailing Address - Fax:
Practice Address - Street 1:10415 ABISSO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2572
Practice Address - Country:US
Practice Address - Phone:702-716-2098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist