Healthcare Provider Details

I. General information

NPI: 1558320804
Provider Name (Legal Business Name): MICHELLE DIANNE SHULTZ R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE DIANNE HILDEBRAND R.D., L.D.

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NE 8TH STREET
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

925 NE 8TH STREET
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-236-3043
  • Fax: 405-239-2390
Mailing address:
  • Phone: 405-236-3043
  • Fax: 405-239-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number927
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: