Provider Demographics
NPI:1992940662
Name:PANDO, ANA MARIA SOLEDAD
Entity type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:SOLEDAD
Last Name:PANDO
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 1:8 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-5119
Mailing Address - Country:US
Mailing Address - Phone:580-762-9536
Mailing Address - Fax:
Practice Address - Street 1:8 FOREST RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-5119
Practice Address - Country:US
Practice Address - Phone:580-762-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL 0025575164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse