| Organization Name: | PBA WELLNESS,LLC |
| NPI Number: | 1619304847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH CHRISTINE MILLER (DIETITIAN) |
| Mailing Address: | 4775 E 91st St Tulsa |
| State: | OK US |
| Postal Code: | 741372801 |
| Phone Number: | 9184962000 |
| Fax Number: | 9184962338 |
| NPI Enumeration Date: | 10/02/2013 |
| NPI Last Update Date: | 10/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 1678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |