Provider Demographics
NPI:1780399246
Name:PANNELL, EDWARD K JR
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:K
Last Name:PANNELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27078 OAKWOOD CIR APT 111
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3528
Mailing Address - Country:US
Mailing Address - Phone:216-414-2547
Mailing Address - Fax:
Practice Address - Street 1:27078 OAKWOOD CIR APT 111
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-3528
Practice Address - Country:US
Practice Address - Phone:216-414-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide