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General NPI Number Information
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NPI Number | 1316445570
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Entity Type | Organization
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Legal Business Name | NUTRITION BY PETRA
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3261 24TH AVE NW STE 101
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City | NORMAN
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State | OK
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Zip | 73069-6666
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Country | US
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Telephone | 405-492-6282
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Fax |
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Provider Business Mailing Address
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Address Line | 10913 ROCK RIDGE RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-5222
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Country | US
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Telephone | 858-352-8354
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Fax |
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Authorized Official
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Title or Position | OWNER, DIETITIAN
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Name | PETRA COLINDRES
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Credential | MA, RDN/LD, IBCLC
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Telephone | 405-492-6282
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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 | 2053
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License Number State | OK
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