Provider Demographics
NPI:1902177660
Name:MARTIN, ERIN (RD/LD)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MARTIN
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 1:4334 NW EXPRESSWAY STE 163
Mailing Address - Street 2:SUITE 163
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1515
Mailing Address - Country:US
Mailing Address - Phone:405-942-4308
Mailing Address - Fax:405-942-6011
Practice Address - Street 1:4334 NW EXPRESSWAY STE 163
Practice Address - Street 2:SUITE 163
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1515
Practice Address - Country:US
Practice Address - Phone:405-942-4308
Practice Address - Fax:405-942-6011
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered