Healthcare Provider Details

I. General information

NPI: 1659325777
Provider Name (Legal Business Name): JENNIFER ANN PANASCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 WINGHAVEN BLVD SUITE 240
O FALLON MO
63368-3617
US

IV. Provider business mailing address

5551 WINGHAVEN BLVD SUITE 240
O FALLON MO
63368-3617
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5561
  • Fax: 636-561-5557
Mailing address:
  • Phone: 636-561-5561
  • Fax: 636-561-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110462
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: