| Organization Name: | NUTRITION SPECIALISTS OF NORTHEASTERN OKLAHOMA |
| NPI Number: | 1902299639 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BEVERLY LYNN PRENTICE (NUTRITION THERAPIST/OWNER) |
| Mailing Address: | 10105 N Bridgewater Cir Owasso |
| State: | OK US |
| Postal Code: | 740557727 |
| Phone Number: | 9182724207 |
| Fax Number: | 8662961005 |
| NPI Enumeration Date: | 03/04/2015 |
| NPI Last Update Date: | 03/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |