Provider Demographics
NPI:1124771720
Name:MANNING, MELISSA (FNTP, FSS, ONC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:FNTP, FSS, ONC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 N HORNE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3610
Mailing Address - Country:US
Mailing Address - Phone:208-283-3599
Mailing Address - Fax:
Practice Address - Street 1:654 N HORNE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3610
Practice Address - Country:US
Practice Address - Phone:208-283-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education