Provider Demographics
NPI:1346237815
Name:STATE OF OK, BOARD OF REGENTS, UNIVERSITY OF OK HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:STATE OF OK, BOARD OF REGENTS, UNIVERSITY OF OK HEALTH SCIENCES CENTER
Other - Org Name:COAH NUTRITION COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC DEAN FOR FIN, ALLIED HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENIELLE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, MPH
Authorized Official - Phone:405-271-2288
Mailing Address - Street 1:DEPARTMENT OF NUTRITIONAL SCIENCES
Mailing Address - Street 2:PO BOX 26901, CHB 469
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73190-0001
Mailing Address - Country:US
Mailing Address - Phone:405-271-2113
Mailing Address - Fax:405-271-1560
Practice Address - Street 1:1600 N PHILLIPS AVE
Practice Address - Street 2:COAH NUTRITION COUNSELING CLINIC
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4619
Practice Address - Country:US
Practice Address - Phone:405-271-2113
Practice Address - Fax:405-271-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty