Provider Demographics
NPI:1770833634
Name:LOVALL, PAMELA PATRICE (LAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PATRICE
Last Name:LOVALL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4590 SW WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0545
Mailing Address - Country:US
Mailing Address - Phone:503-730-8102
Mailing Address - Fax:
Practice Address - Street 1:4590 SW WATSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0545
Practice Address - Country:US
Practice Address - Phone:503-730-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC159414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist