Provider Demographics
NPI:1629441134
Name:PANKO, JOAN (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PANKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:25 CORPORATE PARK RD
Mailing Address - Street 2:PO BOX 396
Mailing Address - City:HOPEWELL JCT
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6562
Mailing Address - Country:US
Mailing Address - Phone:845-282-2198
Mailing Address - Fax:
Practice Address - Street 1:730 HORTONTOWN RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JCT
Practice Address - State:NY
Practice Address - Zip Code:12533-6843
Practice Address - Country:US
Practice Address - Phone:845-282-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415102-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse