Provider Demographics
NPI:1285773937
Name:NUTRIFIT OF OKLAHOMA LLC
Entity type:Organization
Organization Name:NUTRIFIT OF OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DANETTE
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:405-613-0518
Mailing Address - Street 1:124 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3079
Mailing Address - Country:US
Mailing Address - Phone:405-613-0518
Mailing Address - Fax:
Practice Address - Street 1:124 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3079
Practice Address - Country:US
Practice Address - Phone:405-613-0518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD909133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty