Individual
JESSICA MELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(920) 459-5192
Mailing address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(920) 459-5192
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1320
LICENSE#
WI
Enumeration date
02/23/2016
Last updated
02/23/2016
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