Basic Information
| Provider Information | |||||||||
| NPI: | 1770039190 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOWERS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30161 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489097661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178874442 | ||||||||
| FaxNumber: | 5178874545 | ||||||||
| Practice Location | |||||||||
| Address1: | 5303 S CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489113800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178874305 | ||||||||
| FaxNumber: | 5178874440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2016 | ||||||||
| LastUpdateDate: | 08/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.