Provider Demographics
NPI:1790010262
Name:GREENLEAF, PAMELA J (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:GREENLEAF
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 WOODROW CT
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1618
Mailing Address - Country:US
Mailing Address - Phone:785-335-9107
Mailing Address - Fax:785-536-6544
Practice Address - Street 1:205 E 7TH ST STE 215
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4161
Practice Address - Country:US
Practice Address - Phone:785-335-9107
Practice Address - Fax:785-536-6544
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered