Healthcare Provider Details

I. General information

NPI: 1609141084
Provider Name (Legal Business Name): PAMELA KATHLEEN GREGORY- LOVE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/13/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95121 VILLAGGIO DEGLI ULIVI SIGONELLA, CATANIA
FPO AE
09636-9998
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

V. Phone/Fax

Practice location:
  • Phone: 335-624-3842
  • Fax:
Mailing address:
  • Phone: 757-953-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND5616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: