Provider Demographics
NPI:1659749034
Name:STEENBERGEN, HEIDI (RD, LD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:STEENBERGEN
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 1:111 WHEELER ST SW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4643
Mailing Address - Country:US
Mailing Address - Phone:479-225-0015
Mailing Address - Fax:
Practice Address - Street 1:111 WHEELER ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4643
Practice Address - Country:US
Practice Address - Phone:479-225-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered