Healthcare Provider Details

I. General information

NPI: 1720619687
Provider Name (Legal Business Name): LAURA MORRIS RDLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA POWELL

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 W MEMORIAL RD FL 3
OKLAHOMA CITY OK
73120-8382
US

IV. Provider business mailing address

7800 NW 85TH TER
OKLAHOMA CITY OK
73132-3385
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number922415
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: