Individual
MRS. MICHELE MARIE BRUNSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-8266
Mailing address
6746 E 125TH ST S, BIXBY, OK 74008-2944
(402) 366-5674
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1818
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1818
STATE LISCENSE
OK
Enumeration date
07/25/2017
Last updated
07/25/2017
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