Provider Demographics
NPI:1972044030
Name:BEARCE, MELISSA (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BEARCE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WEINREIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:414 15TH AVE W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4508
Mailing Address - Country:US
Mailing Address - Phone:701-218-0451
Mailing Address - Fax:
Practice Address - Street 1:414 15TH AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4508
Practice Address - Country:US
Practice Address - Phone:701-218-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND934133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered