Healthcare Provider Details

I. General information

NPI: 1891782884
Provider Name (Legal Business Name): JANET MEINDERS CHARALAMPOUS R.D., L.D.10
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 67 BOX 1
DAVIS OK
73030-9501
US

IV. Provider business mailing address

PO BOX 155
DAVIS OK
73030-0155
US

V. Phone/Fax

Practice location:
  • Phone: 580-369-3636
  • Fax: 580-369-3366
Mailing address:
  • Phone: 580-369-3636
  • Fax: 580-369-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD 25
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: