Provider Demographics
NPI:1245772029
Name:MCINTYRE, BROOKE HALEY (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:HALEY
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28149 E 97TH ST S
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-3413
Mailing Address - Country:US
Mailing Address - Phone:918-408-0576
Mailing Address - Fax:
Practice Address - Street 1:28149 E 97TH ST S
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-3413
Practice Address - Country:US
Practice Address - Phone:918-408-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1785133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered