Provider Demographics
NPI:1831575117
Name:MILLER, MELISSA KATE (DTR E)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KATE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DTR E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 PIEDRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-5250
Mailing Address - Country:US
Mailing Address - Phone:575-650-5454
Mailing Address - Fax:
Practice Address - Street 1:110 E APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6902
Practice Address - Country:US
Practice Address - Phone:505-654-7909
Practice Address - Fax:505-564-7956
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist