Basic Information
| Provider Information | |||||||||
| NPI: | 1548393531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANKE | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | JOYCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 KIMBERWICK CT | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449049425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197746872 | ||||||||
| FaxNumber: | 4197746882 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 SCHOLL RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197746872 | ||||||||
| FaxNumber: | 4197746882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 02/23/2012 | ||||||||
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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 | 2084P0804X | 35006890P | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 35006890 | 01 | OH | STATE ID | OTHER | 2081885 | 05 | OH | MEDICAID |