Individual
MS. JOLENE FLORENCE PANGANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
19600 DUBOIS AVE, SOUTH BEND, IN 46637-3826
(574) 344-6742
Mailing address
19600 DUBOIS AVE, SOUTH BEND, IN 46637-3826
(574) 344-6742
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003479A
IN
2255A2300X
Athletic Trainer
—
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
01/26/2019
Last updated
06/03/2021
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