Provider Demographics
NPI:1720015720
Name:PANOFF, BETH (FNP-C-MSN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:PANOFF
Suffix:
Gender:F
Credentials:FNP-C-MSN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:313 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1239
Mailing Address - Country:US
Mailing Address - Phone:914-648-0738
Mailing Address - Fax:
Practice Address - Street 1:313 WAYNE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1239
Practice Address - Country:US
Practice Address - Phone:914-648-0738
Practice Address - Fax:203-779-3560
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334103363LF0000X
NC5007082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily