Provider Demographics
NPI:1144288754
Name:DOLS, MELISSA LYNN (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:DOLS
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320
Mailing Address - Country:US
Mailing Address - Phone:320-493-4039
Mailing Address - Fax:
Practice Address - Street 1:200 W 1ST ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362
Practice Address - Country:US
Practice Address - Phone:320-243-7713
Practice Address - Fax:320-243-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2264133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06927Medicare ID - Type UnspecifiedGROUP
710000379Medicare ID - Type Unspecified