Provider Demographics
NPI:1063235380
Name:PANNELL, NAOMI G
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:G
Last Name:PANNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 NEWSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7110
Mailing Address - Country:US
Mailing Address - Phone:317-735-5067
Mailing Address - Fax:
Practice Address - Street 1:6545 NEWSTEAD DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-7110
Practice Address - Country:US
Practice Address - Phone:317-735-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24017523376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker