Healthcare Provider Details

I. General information

NPI: 1508211749
Provider Name (Legal Business Name): SUSAN LAY N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 NW 177TH ST
EDMOND OK
73012-8917
US

IV. Provider business mailing address

2601 NW 177TH ST
EDMOND OK
73012-8917
US

V. Phone/Fax

Practice location:
  • Phone: 405-226-5808
  • Fax:
Mailing address:
  • Phone: 405-226-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1508211749
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: