Provider Demographics
NPI:1528413457
Name:PANDER, TERESA (LPN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4870
Mailing Address - Country:US
Mailing Address - Phone:724-652-5144
Mailing Address - Fax:724-654-3342
Practice Address - Street 1:831 HARRISON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4870
Practice Address - Country:US
Practice Address - Phone:724-652-5144
Practice Address - Fax:724-654-3342
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN250112L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse