Healthcare Provider Details

I. General information

NPI: 1417333121
Provider Name (Legal Business Name): EMILY MICHELLE WINDEN MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MICHELLE SELLERS

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 S LEWIS AVE STE 325
TULSA OK
74104-5719
US

IV. Provider business mailing address

1531 S GARY PL
TULSA OK
74104-5225
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-9077
  • Fax:
Mailing address:
  • Phone: 918-812-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: