Provider Demographics
NPI:1912375080
Name:WOOSTER, PAMELA JO (RDN, MED, CDE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JO
Last Name:WOOSTER
Suffix:
Gender:F
Credentials:RDN, MED, CDE
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, MED
Mailing Address - Street 1:1024 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8813
Mailing Address - Country:US
Mailing Address - Phone:970-870-1048
Mailing Address - Fax:970-871-2455
Practice Address - Street 1:3001 S LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1790
Practice Address - Country:US
Practice Address - Phone:970-875-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
817360133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education