Individual
JENNIE TILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
5016 W 4TH AVE, STILLWATER, OK 74074-6956
(580) 491-0720
Mailing address
5016 W 4TH AVE, STILLWATER, OK 74074-6956
(580) 491-0720
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2294
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750716767
—
OK
Enumeration date
07/10/2018
Last updated
07/10/2018
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