Provider Demographics
NPI:1811274681
Name:MUSSELMAN, MELINDA C (RD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:C
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 CRAGWOLD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7013
Mailing Address - Country:US
Mailing Address - Phone:816-536-4236
Mailing Address - Fax:877-826-7969
Practice Address - Street 1:11511 CRAGWOLD RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7013
Practice Address - Country:US
Practice Address - Phone:816-536-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered