Active NPI
Melissa Joan Grzybowski
- Registered Dietitian
- Nett Lake, MN
National Provider Identifier
1205134152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2486
- Practice address
- 5219 St. John's Drive
Nett Lake, MN 55772 - Phone
- (217) 757-3650
- NPI assigned
- Mar 2, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2486 | MN | Primary |
Addresses
Primary practice location
5219 St. John's Drive
Nett Lake, MN 55772
Mailing address
3920 13TH Ave E
Suite 6
Hibbing, MN 55746-3675
Phone (218) 263-7540
Other names 1
- Melissa Joan Walli
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2486 | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299024000000",
"number": "1205134152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 13TH AVE E",
"address_2": "SUITE 6",
"city": "HIBBING",
"state": "MN",
"postal_code": "557463675",
"telephone_number": "218-263-7540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5219 ST. JOHN'S DRIVE",
"city": "NETT LAKE",
"state": "MN",
"postal_code": "55772",
"telephone_number": "217-757-3650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRZYBOWSKI",
"first_name": "MELISSA",
"middle_name": "JOAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-02",
"last_updated": "2011-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MELISSA",
"last_name": "WALLI",
"middle_name": "JOAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Nett Lake, MN
- Bois Forte Reservation Tribal Council (Big Woods Transit)
- Bois Forte Reservation Tribal Council (Bois Forte Human Services)
- Bois Forte Reservation Tribal Council (Bois Forte Human Services)
- Bois Forte Reservation Tribal Government
- Bois Forte Reservation Tribal Government (Bois Forte Medical Clinic Pharmacy)
- Lance E Hardwig, P.A,
- Andrew Thomas Jones, DDS
- Julie Skoglund, PHARMD
- St. Louis & Koochiching Cos Ind School Dist 707
- Shanna Rachelle Vidor, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 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.