Healthcare Provider Details

I. General information

NPI: 1851418396
Provider Name (Legal Business Name): MICHAEL YORK RHONE RD LD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16109 HIMALAYA RDG
EDMOND OK
73013-1229
US

IV. Provider business mailing address

16109 HIMALAYA RDG
EDMOND OK
73013-1229
US

V. Phone/Fax

Practice location:
  • Phone: 405-844-0082
  • Fax:
Mailing address:
  • Phone: 405-844-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number993
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: