Individual
SHAWN IDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1800 W UNIVERSITY BLVD, DURANT, OK 74701-3006
(580) 924-3080
(580) 931-2048
Mailing address
1800 W UNIVERSITY BLVD, DURANT, OK 74701-3006
(580) 924-3080
(580) 931-2048
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
509
OK
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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