Individual
MRS. JAIME LOUISE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD/LD
Contact information
Practice address
3112 W QUINCY ST, BROKEN ARROW, OK 74012-9071
(918) 252-7649
Mailing address
3112 W QUINCY ST, BROKEN ARROW, OK 74012-9071
(918) 252-7649
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1408
OK
Other
Enumeration date
09/11/2012
Last updated
09/11/2012
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