Individual
ANDREA DAWN SHOTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS RD LD
Contact information
Practice address
21333 E 104TH ST, BROKEN ARROW, OK 74014-3669
(918) 449-1123
Mailing address
21333 E 104TH ST, BROKEN ARROW, OK 74014-3669
(918) 449-1123
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
1371
TN
133V00000X
Registered Dietitian
Primary
1659
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05376085
—
MS
05
—
200255350 B
—
OK
Enumeration date
06/16/2009
Last updated
02/12/2011
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