Provider Demographics
NPI:1891508669
Name:PANKOKE, INEZ (LPN)
Entity type:Individual
Prefix:
First Name:INEZ
Middle Name:
Last Name:PANKOKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68045-1117
Mailing Address - Country:US
Mailing Address - Phone:402-317-2967
Mailing Address - Fax:
Practice Address - Street 1:500 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NE
Practice Address - Zip Code:68045-1117
Practice Address - Country:US
Practice Address - Phone:402-317-2967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 3747P1801X
NE26880164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant