Provider Demographics
NPI:1033211628
Name:WOODS, SUSAN GAIL (MS, RD/LD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GAIL
Last Name:WOODS
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 1:2056 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-8209
Mailing Address - Country:US
Mailing Address - Phone:405-550-7985
Mailing Address - Fax:405-769-9247
Practice Address - Street 1:2056 WESTBURY DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-8209
Practice Address - Country:US
Practice Address - Phone:405-550-7985
Practice Address - Fax:405-769-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200042020CMedicaid
OK200042020CMedicaid