Provider Demographics
NPI:1003380791
Name:MEALS BY JOLEEN LLC
Entity Type:Organization
Organization Name:MEALS BY JOLEEN LLC
Other - Org Name:JOLEENRD
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED DIETITIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-280-8456
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-2735
Mailing Address - Country:US
Mailing Address - Phone:918-280-8456
Mailing Address - Fax:855-438-6802
Practice Address - Street 1:6336 S 116TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1251
Practice Address - Country:US
Practice Address - Phone:918-280-8456
Practice Address - Fax:855-438-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1842OtherLD
LA2971OtherLD
NE1377OtherLD
OK1842OtherLD
KS1736OtherLD
LA2971OtherLD