Provider Demographics
NPI:1679066682
Name:VERKLER, MAGEN J (NUTRITIONIST)
Entity type:Individual
Prefix:MISS
First Name:MAGEN
Middle Name:J
Last Name:VERKLER
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-3526
Mailing Address - Country:US
Mailing Address - Phone:870-917-8405
Mailing Address - Fax:
Practice Address - Street 1:1001 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-5002
Practice Address - Country:US
Practice Address - Phone:405-375-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty