Provider Demographics
NPI:1154509818
Name:KNUDSON, MELISSA H (RD)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:H
Last Name:KNUDSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31100 TELEGRAPH RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4363
Mailing Address - Country:US
Mailing Address - Phone:248-647-1706
Mailing Address - Fax:248-646-3182
Practice Address - Street 1:31100 TELEGRAPH RD
Practice Address - Street 2:SUITE #110
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4363
Practice Address - Country:US
Practice Address - Phone:248-647-1706
Practice Address - Fax:248-646-3182
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered