Provider Demographics
NPI:1417523267
Name:DUROUSSEAU, PAMELA (MPH, RDN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DUROUSSEAU
Suffix:
Gender:F
Credentials:MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SOLARA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6881
Mailing Address - Country:US
Mailing Address - Phone:540-454-0739
Mailing Address - Fax:
Practice Address - Street 1:180 SOLARA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6881
Practice Address - Country:US
Practice Address - Phone:540-454-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered