Provider Demographics
NPI:1538370903
Name:PANSE, NANCY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:PANSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12729 GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:ETIWANDA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1682
Mailing Address - Country:US
Mailing Address - Phone:909-463-1233
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE
Practice Address - Street 2:SUITE A104
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4331
Practice Address - Country:US
Practice Address - Phone:909-931-1033
Practice Address - Fax:909-981-8976
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 15642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant