Provider Demographics
NPI:1558461301
Name:PANARES, MAUREEN ANN (DNP)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:ANN
Last Name:PANARES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:BEVERLY SHORES
Mailing Address - State:IN
Mailing Address - Zip Code:46301-0421
Mailing Address - Country:US
Mailing Address - Phone:219-989-1235
Mailing Address - Fax:219-989-1237
Practice Address - Street 1:400 LEGACY PLZ W
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5296
Practice Address - Country:US
Practice Address - Phone:219-326-1775
Practice Address - Fax:219-326-1951
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001012A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200541620Medicaid
IN200541620AMedicaid
IN151020024OtherMEDICARE PTAN
IN200541620AMedicaid