Basic Information
| Provider Information | |||||||||
| NPI: | 1366833121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANTANO | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 144 | ||||||||
| Address2: | 45 HUDSON AVE | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128010144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934477 | ||||||||
| FaxNumber: | 5187987541 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 HUDSON AVE | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187934477 | ||||||||
| FaxNumber: | 5187987541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 05/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 001671 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.