Provider Demographics
NPI:1316276090
Name:BENDEL, CONNIE DAVIS (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:DAVIS
Last Name:BENDEL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2606
Mailing Address - Country:US
Mailing Address - Phone:918-749-9077
Mailing Address - Fax:918-749-4041
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:STE 109
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2606
Practice Address - Country:US
Practice Address - Phone:918-749-9077
Practice Address - Fax:918-749-4041
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered