1750570131 NPI number — MRS. PANTEA PARSA MINNOCK RN, CPNP

Table of content: MRS. PANTEA PARSA MINNOCK RN, CPNP (NPI 1750570131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750570131 NPI number — MRS. PANTEA PARSA MINNOCK RN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINNOCK
Provider First Name:
PANTEA
Provider Middle Name:
PARSA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750570131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34TH STREET AND CIVIC CENTER BLVD.
Provider Second Line Business Mailing Address:
11TH FLOOR NW TOWER, SUITE 30
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-590-3618
Provider Business Mailing Address Fax Number:
215-590-3053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34TH STREET AND CIVIC CENTER BLVD
Provider Second Line Business Practice Location Address:
11TH FLOOR NW TOWER, SUITE 30
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-590-3618
Provider Business Practice Location Address Fax Number:
215-590-3053
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  SP009934 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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