Healthcare Provider Details

I. General information

NPI: 1861514044
Provider Name (Legal Business Name): ANNA MARIA REINWAND RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST OSU MEDICAL CENTER, CENTER FOR DIABETES EDUCATION
TULSA OK
74127-9020
US

IV. Provider business mailing address

11724 E 119TH ST N
COLLINSVILLE OK
74021-1022
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-5823
  • Fax: 918-599-1763
Mailing address:
  • Phone: 918-371-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1339
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: