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General NPI Number Information
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NPI Number | 1174155865
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Entity Type | Organization
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Legal Business Name | DIETITIAN ON A MISSION LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 10400 VINEYARD BLVD STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-3830
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Country | US
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Telephone | 405-550-2899
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Fax | 405-242-5345
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Provider Business Mailing Address
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Address Line | 720 N SONGBIRD WAY
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City | MUSTANG
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State | OK
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Zip | 73064-2086
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Country | US
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Telephone | 405-550-2899
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Fax | 405-242-5345
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Authorized Official
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Title or Position | OWNER, REGISTERED DIETITIAN
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Name | MRS. BRITTANY CLAIRE RUNDELL
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Credential | RD
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Telephone | 405-550-2899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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