Provider Demographics
NPI:1952583759
Name:DIERKS, MELISSA HERRMANN (RD, LDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:HERRMANN
Last Name:DIERKS
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-0921
Mailing Address - Country:US
Mailing Address - Phone:704-779-2100
Mailing Address - Fax:704-948-5823
Practice Address - Street 1:625 HOLBROOK STREET
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7723
Practice Address - Country:US
Practice Address - Phone:704-779-2100
Practice Address - Fax:704-948-5823
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered