Provider Demographics
NPI:1508135070
Name:MILLER, TRUDY KATHLEEN (RN, RD/LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:KATHLEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, RD/LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 SANDY LANE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-1152
Mailing Address - Country:US
Mailing Address - Phone:405-789-0050
Mailing Address - Fax:
Practice Address - Street 1:1913 SANDY LANE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1152
Practice Address - Country:US
Practice Address - Phone:405-789-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD705133V00000X
OKR23475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse