Provider Demographics
NPI:1023537966
Name:PANG, JEANETTE CATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:CATHERINE
Last Name:PANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7925 YOUREE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5134
Mailing Address - Country:US
Mailing Address - Phone:182-123-6103
Mailing Address - Fax:318-212-3709
Practice Address - Street 1:7925 YOUREE DR STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5134
Practice Address - Country:US
Practice Address - Phone:318-212-3610
Practice Address - Fax:318-212-3709
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-09-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant