Provider Demographics
NPI:1881726297
Name:SOELLNER, MELISSA ANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:SOELLNER
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 1:22 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1415
Mailing Address - Country:US
Mailing Address - Phone:618-826-4581
Mailing Address - Fax:618-826-1579
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:MEMORIAL HOSPITAL
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1116
Practice Address - Country:US
Practice Address - Phone:618-826-4581
Practice Address - Fax:618-826-1579
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
IL164001250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164001250OtherSTATE LICENSE NUMBER
IL202042Medicare ID - Type UnspecifiedPROVIDER NUMBER