Provider Demographics
NPI:1124697420
Name:TOMCZAK, MELISSA (FDNP, NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TOMCZAK
Suffix:
Gender:F
Credentials:FDNP, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6631 MELDRUM RD
Mailing Address - Street 2:
Mailing Address - City:IRA
Mailing Address - State:MI
Mailing Address - Zip Code:48023-2019
Mailing Address - Country:US
Mailing Address - Phone:586-419-6415
Mailing Address - Fax:
Practice Address - Street 1:6631 MELDRUM RD
Practice Address - Street 2:
Practice Address - City:IRA
Practice Address - State:MI
Practice Address - Zip Code:48023-2019
Practice Address - Country:US
Practice Address - Phone:586-419-6415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education