Individual
MRS. MELISSA L MERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 HIGHWAY 65 S, MORA, MN 55051-1899
(320) 225-3640
Mailing address
16685 EVERGREEN RD, PINE CITY, MN 55063-5108
(320) 679-1212
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1940
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1940
DIETICIAN LICENSE
MN
01
—
859711
AM DIETETIC REGISTRATION
MN
Enumeration date
01/12/2007
Last updated
07/08/2007
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