Provider Demographics
NPI:1578846515
Name:PANKEY, MIA N (LPN)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:N
Last Name:PANKEY
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 1:995 ATLANTIC AVE
Mailing Address - Street 2:APT 756
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1721
Mailing Address - Country:US
Mailing Address - Phone:614-390-9204
Mailing Address - Fax:
Practice Address - Street 1:995 ATLANTIC AVE
Practice Address - Street 2:APT 756
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1721
Practice Address - Country:US
Practice Address - Phone:614-390-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse