Provider Demographics
NPI:1366210254
Name:HOLDEN, MELANIE HICKEN (RD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:HICKEN
Last Name:HOLDEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:HICKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 W BLAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-1904
Mailing Address - Country:US
Mailing Address - Phone:435-817-0321
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD ST # 84107
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86290318133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered