Provider Demographics
NPI:1396916029
Name:OAKS, MELODY (CN)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:OAKS
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21731 N 86TH LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2497
Mailing Address - Country:US
Mailing Address - Phone:602-469-3645
Mailing Address - Fax:623-321-1616
Practice Address - Street 1:21731 N 86TH LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2497
Practice Address - Country:US
Practice Address - Phone:602-469-3645
Practice Address - Fax:623-321-1616
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ501001133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education