Healthcare Provider Details

I. General information

NPI: 1043676943
Provider Name (Legal Business Name): MELISA S. BAIER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ESSIE DAVISON DR
CLARINDA IA
51632-2915
US

IV. Provider business mailing address

220 ESSIE DAVISON DR P.O. BOX 217
CLARINDA IA
51632-2915
US

V. Phone/Fax

Practice location:
  • Phone: 712-542-2176
  • Fax: 712-542-8381
Mailing address:
  • Phone: 712-542-2176
  • Fax: 712-542-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number01709
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: