Provider Demographics
NPI:1649462052
Name:IVERSON, SHARON A (RD)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:IVERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N 14TH ST
Mailing Address - Street 2:DIABETES PROGRAM
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-2028
Mailing Address - Country:US
Mailing Address - Phone:918-623-1424
Mailing Address - Fax:918-623-3013
Practice Address - Street 1:309 N 14TH ST
Practice Address - Street 2:DIABETES PROGRAM
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2028
Practice Address - Country:US
Practice Address - Phone:918-623-1424
Practice Address - Fax:918-623-3013
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered