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General NPI Number Information
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NPI Number | 1205337219
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Entity Type | Individual
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Provider Name | LINDA A VERGILIO-PANEK CNP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2018
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 50583 PRINCETON DR
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City | MACOMB
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State | MI
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Zip | 48044-1269
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Country | US
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Telephone | 313-282-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 50583 PRINCETON DR
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City | MACOMB
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State | MI
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Zip | 48044-1269
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Country | US
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Telephone | 313-282-8811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704160638
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License Number State | MI
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