Provider Demographics
NPI:1467464529
Name:MILLS, GALE A (MS,RD/LD)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:A
Last Name:MILLS
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:RR 1 BOX 268
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-9711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 268
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-9711
Practice Address - Country:US
Practice Address - Phone:918-535-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD532133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered