Individual
MELISSA ANNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3733
(217) 239-2713
(217) 356-7964
Mailing address
2501 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3733
(217) 239-2713
(217) 356-7964
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
164004906
IL
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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