Provider Demographics
NPI:1114152345
Name:PANER, KATHRINA LIBRANDO (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATHRINA
Middle Name:LIBRANDO
Last Name:PANER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 E CHARLESTON BLVD # 230-479
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1021
Mailing Address - Country:US
Mailing Address - Phone:702-734-8014
Mailing Address - Fax:702-734-6677
Practice Address - Street 1:9020 W CHEYENNE AVENUE
Practice Address - Street 2:4000 E. CHARLESTON BLVD #100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:702-240-4233
Practice Address - Fax:702-242-5901
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1159363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical