Provider Demographics
NPI:1053752022
Name:PANLILIO-ORTIZ, MARIA THERESA (GNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:THERESA
Last Name:PANLILIO-ORTIZ
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:THERESA
Other - Last Name:PANLILIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GNP
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-722-7225
Mailing Address - Fax:607-722-0061
Practice Address - Street 1:159 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-3103
Practice Address - Country:US
Practice Address - Phone:607-722-7225
Practice Address - Fax:607-722-0061
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340908363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology