Provider Demographics
NPI:1558125070
Name:TERESA PANGAN PLLC
Entity Type:Organization
Organization Name:TERESA PANGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RDN
Authorized Official - Phone:563-241-5543
Mailing Address - Street 1:3885 TAM O SHANTER DR N
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1945
Mailing Address - Country:US
Mailing Address - Phone:469-667-0000
Mailing Address - Fax:
Practice Address - Street 1:3120 W LOGAN BLVD APT F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1626
Practice Address - Country:US
Practice Address - Phone:563-241-5543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty