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Organization
MLB NUTRITION & WELLNESS, LLC
Active
Organization
MLB NUTRITION & WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA LYNN BOLLMAN M.S., R.D. (PRESIDENT)
(917) 680-2820
Entity
Organization
Contact information
Practice address
10101 SE MAIN ST, PORTLAND, OR 97216-2455
(917) 680-2820
Mailing address
5071 W SUNSET DR, LAKE OSWEGO, OR 97035-4253
(917) 680-2820
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
LDD10144515
OR
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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