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Oklahoma Board of Medical Licensure and Supervision

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WAGNER, MELISSA DAWN       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: U.S. FOODSERVICE
10211 NORTH I-35 SERVICE RD
OKLAHOMA CITY OK 73131

Address last updated on 10/2/2012
Phone #: (405) 475-4660 x2158
Fax #:
County: OKLAHOMA
License: 1397
Dated: 11/3/2005
Expires: 10/31/2013
Temp. Ltr. Issued: 7/28/2005
Temp. Ltr. Expires: 11/5/2005
License Type: Licensed Dietitian
Specialty:
Status: Inactive
Status Class: Expired License
Restricted to:
CME Year: 0
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
U.S. FOODSERVICE
10211 NORTH I-35 SERVICE RD
OKLAHOMA CITY OK 73131

Phone #: (405) 475-4660 x2158
Fax #:

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