Provider Demographics
NPI:1346367653
Name:MANIS, ELIZABETH SCHNATTERER (RD,LD,CDE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SCHNATTERER
Last Name:MANIS
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MANIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,LD,CDE
Mailing Address - Street 1:2117 E 25TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2917
Mailing Address - Country:US
Mailing Address - Phone:918-744-1130
Mailing Address - Fax:
Practice Address - Street 1:1265 S UTICA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-579-3384
Practice Address - Fax:918-579-3305
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK541133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered