Healthcare Provider Details

I. General information

NPI: 1346303021
Provider Name (Legal Business Name): MELODY ENGEL M.S., R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE NUTRITION SERVICES DEPT.
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

3226 W KING ARTHURS CT
GREENFIELD WI
53221-3138
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6711
  • Fax:
Mailing address:
  • Phone: 414-649-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number599029
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: