Provider Demographics
NPI:1356550784
Name:PANGALLO, MELISSA S (CNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:PANGALLO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10032 DEMIA WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4734
Mailing Address - Country:US
Mailing Address - Phone:859-647-6700
Mailing Address - Fax:
Practice Address - Street 1:10032 DEMIA WAY STE 225
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4734
Practice Address - Country:US
Practice Address - Phone:859-647-6700
Practice Address - Fax:859-372-6362
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner