Provider Demographics
NPI:1710235312
Name:NUTRITION RESOURCES PLC
Entity Type:Organization
Organization Name:NUTRITION RESOURCES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JENNETTE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:918-401-0006
Mailing Address - Street 1:10746 E 120TH COURT N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-5542
Mailing Address - Country:US
Mailing Address - Phone:918-401-0006
Mailing Address - Fax:877-380-4628
Practice Address - Street 1:10306 N 138TH E AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4677
Practice Address - Country:US
Practice Address - Phone:918-401-0006
Practice Address - Fax:877-380-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1550133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200117350CMedicaid