Provider Demographics
NPI:1497907679
Name:PAGANO, ANNA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LAKESIDE PARK
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4078
Mailing Address - Country:US
Mailing Address - Phone:215-364-1400
Mailing Address - Fax:
Practice Address - Street 1:506 LAKESIDE PARK
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-364-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN537232163W00000X
PA2007002133-03163WP0809X
PASP020859363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult