MEDICARE: YOUR NUTRITION TEAM

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	713	OK

General Provider Information

NPI Number	:	1750716767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR NUTRITION TEAM

Provider Business Mailing Address
First Line	:	2056 WESTBURY DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2056 WESTBURY DR
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-8209
Country	:	US
Telephone Number	:	405-550-7985
Fax Number	:	405-769-9247

Authorized Official
Title or Position	:	OWNER/DIETITIAN
Name	:	MS. SUSAN G. WOODS
Credential	:	MS, RD/LD
Telephone Number	:	405-550-7985

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	09/09/2013

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