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NPI Code Detail

MEDICARE: MS. PAMELA JEAN RUSSELL R.D., L.D.

MEDICARE: MS. PAMELA JEAN RUSSELL R.D., L.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian2008001872MO

General Provider Information

NPI Number : 1083892632
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA JEAN RUSSELL R.D., L.D.
Provider Business Mailing Address
First Line : 6065 HELEN AVE
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2013
Country : US
Telephone Number : 314-522-6410
Fax Number :
Provider Business Practice Location Address
First Line : 6065 HELEN AVE
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2013
Country : US
Telephone Number : 314-522-6410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2008
Last Update Date : 02/06/2008

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