Healthcare Provider Details

I. General information

NPI: 1619885266
Provider Name (Legal Business Name): BARNUM NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S 87TH ST
MESA AZ
85209-5293
US

IV. Provider business mailing address

2012 S 87TH ST
MESA AZ
85209-5293
US

V. Phone/Fax

Practice location:
  • Phone: 480-662-0844
  • Fax:
Mailing address:
  • Phone: 480-662-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELINDA NICHOLE BARNUM
Title or Position: OWNER
Credential: MS, RD, CCTD
Phone: 480-662-0844