Provider Demographics
NPI:1083320451
Name:PANKASKIE, RENEE ELAINE (DNP-FNP, NP-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ELAINE
Last Name:PANKASKIE
Suffix:
Gender:F
Credentials:DNP-FNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:KS
Mailing Address - Zip Code:66852-9272
Mailing Address - Country:US
Mailing Address - Phone:913-991-2115
Mailing Address - Fax:
Practice Address - Street 1:1201 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2504
Practice Address - Country:US
Practice Address - Phone:620-343-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-161397363L00000X
KS53-81895-091363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner