Provider Demographics
NPI:1811734239
Name:LIPKA, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:LIPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:PATYKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCN
Mailing Address - Street 1:2083 MOZART AVE
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-7929
Mailing Address - Country:US
Mailing Address - Phone:586-243-7762
Mailing Address - Fax:
Practice Address - Street 1:2083 MOZART AVE
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-7929
Practice Address - Country:US
Practice Address - Phone:586-243-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist