Provider Demographics
NPI:1821395419
Name:GAARD, PAMELA GAIL (RD, LD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GAIL
Last Name:GAARD
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 1:5045 ABBOTT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2142
Mailing Address - Country:US
Mailing Address - Phone:612-926-2974
Mailing Address - Fax:
Practice Address - Street 1:5045 ABBOTT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-2142
Practice Address - Country:US
Practice Address - Phone:612-926-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2975133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered