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Organization

NUTRITION CORE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CRYSTAL BROOK BUNNEY MSHA, RD/LD (REGISTERED DIETITIAN)
(918) 557-0022
Entity
Organization

Contact information

Practice address
1305 N HIGHWAY 66, SUITE B, CATOOSA, OK 74015-2460
(918) 557-0022
Mailing address
15336 E 470 RD, CLAREMORE, OK 74017-5372

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1312
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1285716803
NPI
OK
05
200049320B
OK
Enumeration date
09/30/2010
Last updated
09/30/2010
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