Provider Demographics
NPI:1811306640
Name:GROTTANELLI, PAMALA NANETTE (ARNP)
Entity type:Individual
Prefix:MS
First Name:PAMALA
Middle Name:NANETTE
Last Name:GROTTANELLI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2273
Mailing Address - Country:US
Mailing Address - Phone:888-350-3380
Mailing Address - Fax:804-767-8334
Practice Address - Street 1:5620 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2273
Practice Address - Country:US
Practice Address - Phone:888-350-3380
Practice Address - Fax:804-767-8334
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171690363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health