Provider Demographics
NPI:1447499660
Name:VEAZEY, LARA RENEE (MA, RD/LD)
Entity type:Individual
Prefix:MISS
First Name:LARA
Middle Name:RENEE
Last Name:VEAZEY
Suffix:
Gender:F
Credentials:MA, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 S LEWIS AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5733
Mailing Address - Country:US
Mailing Address - Phone:918-749-9077
Mailing Address - Fax:918-749-4041
Practice Address - Street 1:2021 S LEWIS AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5733
Practice Address - Country:US
Practice Address - Phone:918-749-9077
Practice Address - Fax:918-749-4041
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered