Provider Demographics
NPI:1174155865
Name:DIETITIAN ON A MISSION LLC
Entity type:Organization
Organization Name:DIETITIAN ON A MISSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:RUNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:405-550-2899
Mailing Address - Street 1:720 N SONGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-2086
Mailing Address - Country:US
Mailing Address - Phone:405-550-2899
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:10400 VINEYARD BLVD STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3830
Practice Address - Country:US
Practice Address - Phone:405-550-2899
Practice Address - Fax:405-242-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty