Provider Demographics
NPI:1487045910
Name:BONCHER, MELISSA (MS RD CD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BONCHER
Suffix:
Gender:F
Credentials:MS RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-3210
Mailing Address - Country:US
Mailing Address - Phone:319-385-2266
Mailing Address - Fax:
Practice Address - Street 1:1700 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-3210
Practice Address - Country:US
Practice Address - Phone:319-385-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2715-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered