Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01078870A | IN |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01078870A | IN |
NPI | 1659613818 |
---|---|
Provider Name | Ms. Christine Pan |
First Address | Greenwood, IN 46143-1049 |
Second Address | Greenwood, IN 46143-1049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 16/03/2021 |