Provider Demographics
NPI:1790003655
Name:SHILLING, MARY (RD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SHILLING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RHYNERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 EVERETT DR
Mailing Address - Street 2:BNP 603
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5047
Mailing Address - Country:US
Mailing Address - Phone:405-271-5501
Mailing Address - Fax:405-271-4802
Practice Address - Street 1:1200 EVERETT DR
Practice Address - Street 2:BNP 603
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5047
Practice Address - Country:US
Practice Address - Phone:405-271-5501
Practice Address - Fax:405-271-4802
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL082612090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered