Provider Demographics
NPI:1932934882
Name:MARSHALL, MELANIE (RDN)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 E CRANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2606
Mailing Address - Country:US
Mailing Address - Phone:801-668-7104
Mailing Address - Fax:
Practice Address - Street 1:1168 E CRANDALL AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2606
Practice Address - Country:US
Practice Address - Phone:801-668-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86031700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered