Provider Demographics
NPI:1902664725
Name:DOUGLASS, MELANIE (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DOUGLASS
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:UT
Mailing Address - Zip Code:84327-0212
Mailing Address - Country:US
Mailing Address - Phone:435-799-4412
Mailing Address - Fax:
Practice Address - Street 1:1655 N 200 E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1945
Practice Address - Country:US
Practice Address - Phone:435-753-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered