Provider Demographics
NPI:1194123497
Name:STEELE, HEATHER (RD/LD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:JACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:1100 E KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2067
Mailing Address - Country:US
Mailing Address - Phone:918-251-5800
Mailing Address - Fax:
Practice Address - Street 1:1100 E KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2067
Practice Address - Country:US
Practice Address - Phone:918-251-5800
Practice Address - Fax:918-251-2926
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered