Individual
LOUISE RENEE WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
1717 N 12TH ST, BROKEN ARROW, OK 74012-9394
(918) 808-0629
Mailing address
1717 N 12TH ST, BROKEN ARROW, OK 74012-9394
(918) 808-0629
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
613
OK
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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