Healthcare Provider Details

I. General information

NPI: 1538468673
Provider Name (Legal Business Name): CHERYL CHRISTINE MONROE RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 S MINGO RD
TULSA OK
74133-5841
US

IV. Provider business mailing address

8921 S MINGO RD
TULSA OK
74133-5841
US

V. Phone/Fax

Practice location:
  • Phone: 918-252-8000
  • Fax: 918-684-3566
Mailing address:
  • Phone: 918-252-8000
  • Fax: 918-684-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1770
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1770
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: