Provider Demographics
NPI:1538623236
Name:PANKA, HALEY MYKEL (ND)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:MYKEL
Last Name:PANKA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:38640 GOLF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-8443
Mailing Address - Country:US
Mailing Address - Phone:612-568-8382
Mailing Address - Fax:
Practice Address - Street 1:901 1ST ST N STE 901A
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7526
Practice Address - Country:US
Practice Address - Phone:612-568-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1100175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1100OtherMINNESOTA BOARD OF MEDICAL PRACTICE
WI6031-170OtherTHE STATE OF WISCONSIN NATUROPATHIC MEDICINE EXAMINING BOARD