Provider Demographics
NPI:1497298350
Name:LUNDY, COURTNEY (RD, LD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 PALMER CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6349
Mailing Address - Country:US
Mailing Address - Phone:405-360-7100
Mailing Address - Fax:405-364-9112
Practice Address - Street 1:2405 PALMER CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6349
Practice Address - Country:US
Practice Address - Phone:405-360-7100
Practice Address - Fax:405-364-9112
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered