Provider Demographics
NPI:1467736090
Name:TAPP, SUZANNE M (RD,LD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:TAPP
Suffix:
Gender:F
Credentials:RD,LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 N PORTLAND AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-4003
Mailing Address - Country:US
Mailing Address - Phone:405-312-2326
Mailing Address - Fax:405-418-4442
Practice Address - Street 1:14000 N PORTLAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-4003
Practice Address - Country:US
Practice Address - Phone:405-312-2326
Practice Address - Fax:405-418-4442
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK160133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK160OtherSTATE LICENSE
OK370211Medicare UPIN