Individual
LISA M REILY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2825 PARKLAWN DR, MIDWEST CITY, OK 73110-4201
(405) 610-8728
Mailing address
2401 KINGSLEY LN, OKLAHOMA CITY, OK 73128-4924
(405) 923-9356
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1182
OK
Other
Enumeration date
11/28/2015
Last updated
11/28/2015
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