Provider Demographics
NPI:1104925619
Name:BASNER, MARSHA ANN (RD)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:ANN
Last Name:BASNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 E 30TH PL N
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-2421
Mailing Address - Country:US
Mailing Address - Phone:918-835-8509
Mailing Address - Fax:
Practice Address - Street 1:3324 E 30TH PL N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-2421
Practice Address - Country:US
Practice Address - Phone:918-835-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD419133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education