Individual
MELISSA GAYLE VAVRICKA-CONAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Mailing address
1001 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-4570
(580) 421-6283
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1179
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1179
STATE LICENSE #
OK
Enumeration date
03/16/2007
Last updated
07/08/2007
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