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General NPI Number Information
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NPI Number | 1679984884
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Entity Type | Individual
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Provider Name | MR. JOSEPH JOHANNAN PANNAPARA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 111 S 11TH ST # 8490
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4824
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Country | US
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Telephone | 215-955-6161
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Fax | 215-923-5507
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Provider Business Mailing Address
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Address Line | 901 N PENN ST UNIT P1805
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3142
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Country | US
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Telephone | 215-300-7393
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NR14443900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | L1-0039648
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN563132
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License Number State | PA
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