Provider Demographics
NPI:1114246220
Name:BRADEN, LISA A (MA, RD/LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:BRADEN
Suffix:
Gender:F
Credentials:MA, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N PHILLIPS AVE
Mailing Address - Street 2:9TH FLOOR, SUITE 9500
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-271-2006
Mailing Address - Fax:
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:9TH FLOOR, SUITE 9500
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered