Provider Demographics
NPI:1205980398
Name:BUTLER, DANIELLE J (RD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9516 S SHIELDS BLVD
Mailing Address - Street 2:59
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3100
Mailing Address - Country:US
Mailing Address - Phone:405-625-7302
Mailing Address - Fax:
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 14100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1273133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered