Healthcare Provider Details

I. General information

NPI: 1609209535
Provider Name (Legal Business Name): MELODY A VICARI-WARNER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY A. VICARI R.D

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

IV. Provider business mailing address

3100 N TENAYA WAY
LAS VEGAS NV
89128-0436
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1042066
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: