MEDICARE: TERESA PANGAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1558125070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA PANGAN PLLC

Provider Business Mailing Address
First Line	:	3885 TAM O SHANTER DR N
Second Line	:
City	:	BETTENDORF
State	:	IA
Zip	:	52722-1945
Country	:	US
Telephone Number	:	469-667-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 W LOGAN BLVD APT F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1626
Country	:	US
Telephone Number	:	563-241-5543
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED DIETITIAN NUTRITIONIST
Name	:	TERESA PANGAN
Credential	:	PHD, RDN
Telephone Number	:	563-241-5543

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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