MLB Nutrition & Wellness, LLC

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

License

LDD10144515 Issued in OR

Legal business name

MLB NUTRITION & WELLNESS, LLC

Practice address

10101 SE Main St
Portland, OR 97216-2455

Phone

(917) 680-2820

NPI assigned

Dec 21, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Melissa Lynn Bollman, M.S., R.D.

Title

President

Phone

(917) 680-2820

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1124397062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5071 W SUNSET DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354253",
            "telephone_number": "917-680-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 SE MAIN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162455",
            "telephone_number": "917-680-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLB NUTRITION & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "BOLLMAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-680-2820",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S., R.D."
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "OR",
            "license": "LDD10144515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Metabolic Nutrition Registered Dietitian in Portland, OR
• Providers in Portland, OR by specialty
• Metabolic Nutrition Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.