Provider Demographics
NPI:1811522428
Name:SHINEFIELD, NICOLE (RD/LD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SHINEFIELD
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 1:909 26TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6366
Mailing Address - Country:US
Mailing Address - Phone:405-801-2323
Mailing Address - Fax:
Practice Address - Street 1:909 26TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6366
Practice Address - Country:US
Practice Address - Phone:405-801-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2008133V00000X
OK770133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered