Provider Demographics
NPI:1790010262
Name:GREENLEAF, PAMELA J (RD, LD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:GREENLEAF
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8533 E 32ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2611
Mailing Address - Country:US
Mailing Address - Phone:316-687-3100
Mailing Address - Fax:316-687-0286
Practice Address - Street 1:8533 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2611
Practice Address - Country:US
Practice Address - Phone:316-687-3100
Practice Address - Fax:316-687-0286
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered