Healthcare Provider Details

I. General information

NPI: 1467464529
Provider Name (Legal Business Name): GALE A. MILLS M.S.,R.D./L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 268
BARNSDALL OK
74002-9711
US

IV. Provider business mailing address

RR 1 BOX 268
BARNSDALL OK
74002-9711
US

V. Phone/Fax

Practice location:
  • Phone: 918-535-2802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD532
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: