MEDICARE: MELISSA E MARQUARDT MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DIET.DI.70020969	WA
2	133V00000X	Registered Dietitian	DT93222	TX

General Provider Information

NPI Number	:	1659646446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA E MARQUARDT MS, RD

Provider Business Mailing Address
First Line	:	3616 NW OREGON CT
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-8619
Country	:	US
Telephone Number	:	954-243-4216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3616 NW OREGON CT
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-8619
Country	:	US
Telephone Number	:	954-243-4216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	06/18/2026

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