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General NPI Number Information
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NPI Number | 1902564180
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Entity Type | Organization
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Legal Business Name | MIRANDA BROWN NUTRITION AND WELLNESS LLC
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 1638 S CARSON AVE APT 403
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City | TULSA
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State | OK
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Zip | 74119-4235
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Country | US
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Telephone | 918-671-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 1638 S CARSON AVE APT 403
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City | TULSA
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State | OK
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Zip | 74119-4235
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Country | US
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Telephone | 918-671-0880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MIRANDA CAROLE BROWN
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Credential | RDN
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Telephone | 918-671-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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