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: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 MARVIN RD NE
LACEY WA
98516-3138
US

IV. Provider business mailing address

2555 MARVIN RD NE
LACEY WA
98516-3138
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-7567
  • Fax: 360-412-6468
Mailing address:
  • Phone: 360-493-7567
  • Fax: 360-412-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60068489
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberDI60068489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: