Provider Demographics
NPI:1013339399
Name:BRUMLEY, NINA (RD LD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:BRUMLEY
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 1:2130 RED ELM DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5659
Mailing Address - Country:US
Mailing Address - Phone:405-285-4762
Mailing Address - Fax:405-285-4352
Practice Address - Street 1:120 N BRYANT AVE
Practice Address - Street 2:SUITE A9
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6302
Practice Address - Country:US
Practice Address - Phone:405-285-4762
Practice Address - Fax:405-285-4352
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1063142133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered