Provider Demographics
NPI:1174976286
Name:PANOZZO, NEELIE MICHELLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:NEELIE
Middle Name:MICHELLE
Last Name:PANOZZO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NEELIE
Other - Middle Name:MICHELLE
Other - Last Name:LINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 BUTTERFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2959
Mailing Address - Country:US
Mailing Address - Phone:815-936-6500
Mailing Address - Fax:815-936-6502
Practice Address - Street 1:1601 BUTTERFIELD TRL
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2959
Practice Address - Country:US
Practice Address - Phone:815-936-6500
Practice Address - Fax:815-936-6502
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily