Provider Demographics
NPI:1033812730
Name:PAVLOV, ZELLA (MA, RDN/LD)
Entity Type:Individual
Prefix:
First Name:ZELLA
Middle Name:
Last Name:PAVLOV
Suffix:
Gender:F
Credentials:MA, RDN/LD
Other - Prefix:
Other - First Name:ZELLA
Other - Middle Name:
Other - Last Name:CLASSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RDN/LD
Mailing Address - Street 1:10701 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2536
Mailing Address - Country:US
Mailing Address - Phone:580-227-7385
Mailing Address - Fax:
Practice Address - Street 1:783 GRAND CASINO BLVD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804
Practice Address - Country:US
Practice Address - Phone:405-214-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered