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General NPI Number Information
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NPI Number | 1043841893
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Entity Type | Individual
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Provider Name | CODY WERNEBURG
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Gender | Male
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 3300 HEALTHPLEX PKWY
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City | NORMAN
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State | OK
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Zip | 73072-9749
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Country | US
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Telephone | 405-515-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 5246 MOCKINGBIRD LN
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City | BLANCHARD
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State | OK
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Zip | 73010-7814
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number |
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License Number State |
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