MEDICARE: MRS. TIFFANI MARIE NELMS RD/LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1995	OK

General Provider Information

NPI Number	:	1730581836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANI MARIE NELMS RD/LD

Provider Business Mailing Address
First Line	:	4775 E 91ST ST STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-2805
Country	:	US
Telephone Number	:	918-551-7901
Fax Number	:	918-388-1059

Provider Business Practice Location Address
First Line	:	4775 E 91ST ST STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-2805
Country	:	US
Telephone Number	:	918-551-7901
Fax Number	:	918-388-1059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	07/22/2015

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