Provider Demographics
NPI:1023381688
Name:GROVES, SHEILA J (MS, RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:J
Last Name:GROVES
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 INTEGRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8864
Mailing Address - Country:US
Mailing Address - Phone:405-773-6606
Mailing Address - Fax:405-471-0024
Practice Address - Street 1:4801 INTEGRIS PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-773-6606
Practice Address - Fax:405-471-0024
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1053133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered