# MLB NUTRITION & WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124397062
- **Authorized official:** MS. MELISSA LYNN BOLLMAN M.S., R.D. (PRESIDENT)
- **Authorized official phone:** (917) 680-2820

## Contact information

- **Practice address:** 10101 SE MAIN ST, PORTLAND, OR 97216-2455
- **Practice address phone:** (917) 680-2820
- **Mailing address:** 5071 W SUNSET DR, LAKE OSWEGO, OR 97035-4253
- **Mailing address phone:** (917) 680-2820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1006X | Metabolic Nutrition Registered Dietitian | LDD10144515 | OR | Yes |

## Other

- **Enumeration date:** 12/21/2011
- **Last updated:** 12/21/2011