Individual
REBECCA PANKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 UNIVERSITY BLVD, SUITE 1295, INDIANAPOLIS, IN 46202-5149
(317) 944-8330
(317) 944-7648
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71005044A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201250400
—
IN
Enumeration date
08/15/2014
Last updated
02/03/2023
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