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General NPI Number Information
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NPI Number | 1306428222
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Entity Type | Individual
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Provider Name | MARQUELLE R BROWN NUTRITIONIST
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 8805 N 145TH EAST AVE STE 105
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City | OWASSO
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State | OK
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Zip | 74055-8530
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Country | US
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Telephone | 918-645-0427
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Fax |
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Provider Business Mailing Address
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Address Line | 14530 E 126TH ST N
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City | COLLINSVILLE
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State | OK
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Zip | 74021-5663
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Country | US
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Telephone | 918-645-0427
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | CNS16907
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License Number State | OK
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