Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP010360 | PA |
N | 363LA2200X | Nurse Practitioner - Adult Health | SP010360 | PA |
N | 363LC1500X | Nurse Practitioner - Community Health | SP010360 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP010360 | PA |
NPI | 1962634659 |
---|---|
Provider Name | Mr. Jean J Pantal |
First Address | Danville, PA 17822-4903 |
Second Address | Wilkes Barre, PA 18702-3542 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 30/07/2019 |