Provider Demographics
NPI:1336020494
Name:DURBIN, PAMELA ELIZABETH
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:DURBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 5TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55046-8605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:LONSDALE
Practice Address - State:MN
Practice Address - Zip Code:55046-8605
Practice Address - Country:US
Practice Address - Phone:612-245-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty