Provider Demographics
NPI:1235487414
Name:PANTANO, VYNESSA (LMT)
Entity Type:Individual
Prefix:
First Name:VYNESSA
Middle Name:
Last Name:PANTANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10479 FAIR OAKS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4141
Mailing Address - Country:US
Mailing Address - Phone:518-253-0687
Mailing Address - Fax:
Practice Address - Street 1:10479 FAIR OAKS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4141
Practice Address - Country:US
Practice Address - Phone:518-253-0687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula