Provider Demographics
NPI:1992509400
Name:HORSTMAN, MELISSA (MS RD LDN)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:HORSTMAN
Suffix:
Gender:
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SUN STAR DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-7284
Mailing Address - Country:US
Mailing Address - Phone:252-470-9853
Mailing Address - Fax:
Practice Address - Street 1:1701 SUN STAR DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-7284
Practice Address - Country:US
Practice Address - Phone:252-470-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1099882133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered