Provider Demographics
NPI:1316032949
Name:EMAMIAN, DOROTHEA (MS, RD/LD)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:EMAMIAN
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 1:4600 KAREN DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8143
Mailing Address - Country:US
Mailing Address - Phone:405-694-8242
Mailing Address - Fax:
Practice Address - Street 1:4600 KAREN DRIVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8143
Practice Address - Country:US
Practice Address - Phone:405-694-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered