Provider Demographics
NPI:1720775471
Name:DRUIEN, MELISSA (LD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DRUIEN
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 MORGAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5142
Mailing Address - Country:US
Mailing Address - Phone:940-613-4766
Mailing Address - Fax:
Practice Address - Street 1:3555 NW 58TH ST STE 910-W
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4707
Practice Address - Country:US
Practice Address - Phone:405-885-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered