Provider Demographics
NPI:1871725978
Name:NUTRITIONAL VOICES LLC
Entity type:Organization
Organization Name:NUTRITIONAL VOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SHOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LD
Authorized Official - Phone:918-449-1123
Mailing Address - Street 1:21333 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-3669
Mailing Address - Country:US
Mailing Address - Phone:918-449-1123
Mailing Address - Fax:
Practice Address - Street 1:21333 E 104TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-3669
Practice Address - Country:US
Practice Address - Phone:918-449-1123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-22
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200258510 AMedicaid
OKOKB5723Medicare PIN