Provider Demographics
NPI:1629022991
Name:DOVE, PAM (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JENTOFT RD
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-1216
Mailing Address - Country:US
Mailing Address - Phone:906-524-4797
Mailing Address - Fax:
Practice Address - Street 1:770 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-9536
Practice Address - Country:US
Practice Address - Phone:906-524-2200
Practice Address - Fax:906-524-3408
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI892713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered