| Doctor Name: | MICHAEL PAHANG |
| NPI Number: | 1033592605 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PMHNP |
| License Number: | 28607 |
| Business Practice Address: | 1550 N Crestmont Dr Suite E Meridian, ID - 836422184 |
| Business Phone Number: | 2082884200 |
| Business Fax Number: | 2082884279 |
| Mailing Address: | 1550 N Crestmont Dr, Suite E MERIDIAN |
| State: | ID |
| Postal Code: | 836422184 |
| Phone Number: | 2082884200 |
| Fax Number: | 2082884279 |
| NPI Enumeration Date: | 07/01/2015 |
| NPI Last Update Date: | 07/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 28607 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |