Organization
NUTRITION BY PETRA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETRA COLINDRES MA, RDN/LD, IBCLC (OWNER, DIETITIAN)
(405) 492-6282
Entity
Organization
Contact information
Practice address
3261 24TH AVE NW STE 101, NORMAN, OK 73069-6666
(405) 492-6282
Mailing address
10913 ROCK RIDGE RD, OKLAHOMA CITY, OK 73120-5222
(858) 352-8354
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2053
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407232317
—
OK
05
—
1912414947
—
OK
Enumeration date
01/23/2018
Last updated
03/17/2018
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