Provider Demographics
NPI:1033305859
Name:GLOVER, PAMELA ELISE (RD, LD, MS, CDE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELISE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:RD, LD, MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIVLEY RD SW STE 210
Mailing Address - Street 2:DIABETES CONTROL CENTER
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5116
Mailing Address - Country:US
Mailing Address - Phone:256-265-3067
Mailing Address - Fax:256-265-3073
Practice Address - Street 1:201 SIVLEY RD SW STE 210
Practice Address - Street 2:DIABETES CONTROL CENTER
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5116
Practice Address - Country:US
Practice Address - Phone:256-265-3067
Practice Address - Fax:256-265-3073
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered