Healthcare Provider Details

I. General information

NPI: 1770524126
Provider Name (Legal Business Name): MELISSA L ARMATTA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISSY ARMATTA LDN,RD,CDE,CIPT

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

IV. Provider business mailing address

267 CARMEL WOODS DR
ELLISVILLE MO
63021-4715
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 337-207-9343
  • Fax: 866-438-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1008
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164007494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: