| Doctor Name: | DIANE AGNES PANKOW |
| NPI Number: | 1013137520 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-BC |
| License Number: | 149936 |
| Business Practice Address: | 1071 Blue Hill Ave Milton, MA - 021862302 |
| Business Phone Number: | 6173332182 |
| Business Fax Number: | |
| Mailing Address: | 81 Cottage St, SHARON |
| State: | MA |
| Postal Code: | 020672132 |
| Phone Number: | 7817848197 |
| Fax Number: | |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 149936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |