Healthcare Provider Details

I. General information

NPI: 1932818937
Provider Name (Legal Business Name): PAMELA O MALLORY LPN,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 W STONY HILL CT APT 1B
RICHMOND VA
23235-6849
US

IV. Provider business mailing address

2916 W STONY HILL CT APT 1B
RICHMOND VA
23235-6849
US

V. Phone/Fax

Practice location:
  • Phone: 804-314-8403
  • Fax:
Mailing address:
  • Phone: 804-447-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0002027554
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: