Provider Demographics
NPI:1437269537
Name:BRUEHL, CHRISTIE L (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:L
Last Name:BRUEHL
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:L
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD LD
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6668
Mailing Address - Fax:405-701-6170
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:405-307-5731
Practice Address - Fax:405-307-3719
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD1032133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
700522086Medicare ID - Type UnspecifiedGROUP