Organization
MUSCOGEE CREEK NATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BREANNA RENE DALE RD, LD (DIETITIAN)
(918) 224-9310
Entity
Organization
Contact information
Practice address
1125 E CLEVELAND AVE, SAPULPA, OK 74066-4641
(918) 224-9310
(918) 224-3805
Mailing address
1125 E CLEVELAND AVE, SAPULPA, OK 74066-4641
(918) 224-9310
(918) 224-3805
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2157
OK
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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