Healthcare Provider Details

I. General information

NPI: 1245474808
Provider Name (Legal Business Name): MELANIE L LIPKE CD, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD DIABETES & NUTRITION PROGRAM
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

909 N BROADWAY PBO/CREDENTIALING
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 360-807-7907
  • Fax:
Mailing address:
  • Phone: 425-317-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60068489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: