Provider Demographics
NPI:1518691385
Name:ARELLANO, JADE ALLISON (CNS)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALLISON
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 WESTBROOKE TER
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5844
Mailing Address - Country:US
Mailing Address - Phone:405-693-5257
Mailing Address - Fax:
Practice Address - Street 1:2018 WESTBROOKE TER
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-5844
Practice Address - Country:US
Practice Address - Phone:405-693-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17601133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist