Individual
BRENDA PENDARVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
12505 BARNES TER, MOORE, OK 73170-3408
(405) 380-3031
Mailing address
12505 BARNES TER, MOORE, OK 73170-3408
(405) 380-3031
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133V00000X
Registered Dietitian
LD1295
OK
133VN1005X
Renal Nutrition Registered Dietitian
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD1295
LICENSED DIETITIAN
OK
Enumeration date
11/05/2014
Last updated
11/05/2014
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