Provider Demographics
NPI:1427497478
Name:WESNER, MELISSA ANNE
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:WESNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISSY
Other - Middle Name:
Other - Last Name:WESNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:69 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3610
Mailing Address - Country:US
Mailing Address - Phone:484-574-0235
Mailing Address - Fax:
Practice Address - Street 1:69 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3610
Practice Address - Country:US
Practice Address - Phone:484-574-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005025133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered