Provider Demographics
NPI:1265417059
Name:PANTANO, JOANNE E (ANP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:E
Last Name:PANTANO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:STE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:STE B103
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-5005
Practice Address - Fax:716-712-0160
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3032111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026529201OtherUNIVERA HEALTHCARE
500023938OtherRAILROAD MEDICARE
NY000560652001OtherBLUE CROSS BLUE SHIELD
NY02202477Medicaid
NY9511997OtherINDEPENDENT HEALTH
NY000560652001OtherBLUE CROSS BLUE SHIELD
NY02202477Medicaid