Individual
ANN LOIS FLADIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 453-2266
(918) 453-2196
Mailing address
102 AGNI WAY, TAHLEQUAH, OK 74464-9200
(918) 456-6277
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
637
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
637
MEDICAL LICENSURE
OK
01
—
647795
DIETETIC REGISTRATION
OK
Enumeration date
09/14/2006
Last updated
07/08/2007
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