Provider Demographics
NPI:1891556304
Name:MILUK, MARISSA KAI (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:KAI
Last Name:MILUK
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16631
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-7631
Mailing Address - Country:US
Mailing Address - Phone:818-437-6249
Mailing Address - Fax:
Practice Address - Street 1:1521 LAURENS RD UNIT 16631
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29606-1097
Practice Address - Country:US
Practice Address - Phone:818-437-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2090133V00000X
86083644133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered