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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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