Basic Information
| Provider Information | |||||||||
| NPI: | 1467736090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAPP | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RD,LD, CNSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14000 N PORTLAND AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053122326 | ||||||||
| FaxNumber: | 4054184442 | ||||||||
| Practice Location | |||||||||
| Address1: | 14000 N PORTLAND AVE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731344003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053122326 | ||||||||
| FaxNumber: | 4054184442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2011 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 160 | OK | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 160 | 01 | OK | STATE LICENSE | OTHER |