Provider Demographics
NPI:1811634652
Name:GROGAN, VALERIE E (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:E
Last Name:GROGAN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7418 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4851
Mailing Address - Country:US
Mailing Address - Phone:918-630-7258
Mailing Address - Fax:
Practice Address - Street 1:7418 E 87TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4851
Practice Address - Country:US
Practice Address - Phone:918-630-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered