Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | CNP00214 | NM |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | CNP00214 | NM |
NPI | 1235464710 |
---|---|
Provider Name | Mr. Tom Anthony Pantano |
First Address | Albuquerque, NM 87102-3637 |
Second Address | Albuquerque, NM 87102-3637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2009 |
Last Update Date | 05/04/2016 |