Provider Demographics
NPI:1538468673
Name:MONROE, CHERYL CHRISTINE (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:CHRISTINE
Last Name:MONROE
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 1:300 ROCKEFELLER DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5075
Mailing Address - Country:US
Mailing Address - Phone:918-682-5501
Mailing Address - Fax:918-684-3566
Practice Address - Street 1:300 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5075
Practice Address - Country:US
Practice Address - Phone:918-682-5501
Practice Address - Fax:918-684-3566
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1770133V00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370025Medicaid
OK100700630AMedicare PIN