Provider Demographics
NPI:1770783565
Name:GILLINGHAM, MELANIE B (PHD, RD)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:B
Last Name:GILLINGHAM
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:ANNE
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:OREGON HEALTH & SCIENCE UNIVERSITY
Mailing Address - Street 2:3181 SW SAM JACKSON PARK RD. MAIL CODE L103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-1682
Mailing Address - Fax:503-494-7076
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:503-494-1682
Practice Address - Fax:503-494-7076
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR686133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered