Provider Demographics
NPI:1790778686
Name:VAN GREVENHOF, JANI ANN (MS, RD/LD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:JANI
Middle Name:ANN
Last Name:VAN GREVENHOF
Suffix:
Gender:F
Credentials:MS, RD/LD, CDE
Other - Prefix:
Other - First Name:JANI
Other - Middle Name:ANN
Other - Last Name:TUTTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF NUTRITIONAL SCIENCES
Mailing Address - Street 2:PO BOX 26901, CHB 469
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73190-0001
Mailing Address - Country:US
Mailing Address - Phone:405-271-2113
Mailing Address - Fax:405-271-1560
Practice Address - Street 1:1600 N PHILLIPS AVE
Practice Address - Street 2:COAH NUTRITION COUNSELING CLINIC
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4619
Practice Address - Country:US
Practice Address - Phone:405-271-2113
Practice Address - Fax:405-271-1560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD 999133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7571472OtherAETNA