Provider Demographics
NPI:1285257121
Name:WILLIAMS, GRACE VOSE (MS, RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:VOSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 NW GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-5415
Mailing Address - Country:US
Mailing Address - Phone:405-684-0909
Mailing Address - Fax:
Practice Address - Street 1:6804 NW GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-5415
Practice Address - Country:US
Practice Address - Phone:405-842-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86101515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered