Individual
JANE WALTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
204 PRIMROSE LN, GORE, OK 74435-5605
(918) 316-4572
Mailing address
204 PRIMROSE LN, GORE, OK 74435-5605
(918) 316-4572
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
915
OK
Other
Enumeration date
11/25/2009
Last updated
05/26/2025
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