Healthcare Provider Details

I. General information

NPI: 1528176633
Provider Name (Legal Business Name): MELISSA JEAN DAVIS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N WYATT DRIVE
TUCSON AZ
85712
US

IV. Provider business mailing address

2600 N WYATT DRIVE
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-5437
  • Fax:
Mailing address:
  • Phone: 520-324-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number710059
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: