Provider Demographics
NPI:1518596477
Name:CAYLAN-LINSTROMBERG, CHRISTINNE MELODY (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINNE MELODY
Middle Name:
Last Name:CAYLAN-LINSTROMBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 E 139TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-2932
Mailing Address - Country:US
Mailing Address - Phone:918-504-5166
Mailing Address - Fax:
Practice Address - Street 1:553 E 139TH PL
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-2932
Practice Address - Country:US
Practice Address - Phone:918-504-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1077937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty