Healthcare Provider Details

I. General information

NPI: 1528051414
Provider Name (Legal Business Name): PATTI SUE LANDERS PH.D., R.D./L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PATTI SUE STONE

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N PHILLIPS AVE COAH NUTRITION COUNSELING
OKLAHOMA CITY OK
73104-4619
US

IV. Provider business mailing address

DEPARTMENT OF NUTRITIONAL SCIENCES PO BOX 26901, CHB 469
OKLAHOMA CITY OK
73190-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2113
  • Fax: 405-271-1560
Mailing address:
  • Phone: 405-271-2113
  • Fax: 405-271-1560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD 996
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: