Provider Demographics
NPI:1821275066
Name:NIX, MELINDA G (RD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:G
Last Name:NIX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:G
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-3273
Mailing Address - Fax:503-494-6990
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-3273
Practice Address - Fax:503-494-6990
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001739133V00000X
ORLDD10191786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00001739OtherWA LICENSE