Provider Demographics
NPI:1841400447
Name:MCGUIRE, MELISSA BERLIN (MS, RD, LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BERLIN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MS, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13738 W 76TH CIR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4414
Mailing Address - Country:US
Mailing Address - Phone:913-631-3840
Mailing Address - Fax:
Practice Address - Street 1:13738 W 76TH CIR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66216-4414
Practice Address - Country:US
Practice Address - Phone:913-631-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS275133V00000X
MO2004024279133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered