Healthcare Provider Details

I. General information

NPI: 1144204660
Provider Name (Legal Business Name): ROSEMARY LYNN YURCZYK RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W 7TH AVE
STILLWATER OK
74074-4105
US

IV. Provider business mailing address

2220 W 7TH AVE
STILLWATER OK
74074-4105
US

V. Phone/Fax

Practice location:
  • Phone: 405-377-1988
  • Fax: 405-624-1988
Mailing address:
  • Phone: 405-377-1988
  • Fax: 405-624-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR608042
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: