NPI 1699914168

Larry William Immenschuh, RDLD

Practitioner Registered Dietitian Fort Sill, OK

Practice location

Address: 3009 N. W. Wilson Street, Fort Sill, OK 73503-9042
Phone: (580) 458-2134
Fax: (580) 458-2314
Mailing address: 1406 NE Independence Ave, Lawton, OK 73507-3438

Registered specialties

Registered Dietitian Primary

Dietary & Nutritional Service Providers Taxonomy 133V00000X Licence 630 (OK)

Other Dietitian, Registered providers in Oklahoma →

Registry record

NPI: 1699914168
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Feb 2009
Record last updated: 29 Jan 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.