Provider Demographics
NPI:1932818937
Name:MALLORY, PAMELA O (LPN,IBCLC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:O
Last Name:MALLORY
Suffix:
Gender:F
Credentials:LPN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 W STONY HILL CT APT 1B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6849
Mailing Address - Country:US
Mailing Address - Phone:804-447-6000
Mailing Address - Fax:
Practice Address - Street 1:2916 W STONY HILL CT APT 1B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6849
Practice Address - Country:US
Practice Address - Phone:804-314-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002027554163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant