Provider Demographics
NPI:1649586033
Name:BROWN, MARY DIANNE (MS, RDN, LD, CDE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DIANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, RDN, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-3252
Mailing Address - Country:US
Mailing Address - Phone:405-271-7000
Mailing Address - Fax:405-271-7014
Practice Address - Street 1:1000 N LINCOLN BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-3252
Practice Address - Country:US
Practice Address - Phone:405-271-7000
Practice Address - Fax:405-271-7014
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD 176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered