Provider Demographics
NPI:1114989779
Name:CARRIER, STEPHEN M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:CARRIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3272
Mailing Address - Fax:702-667-4667
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-877-8661
Practice Address - Fax:702-258-1322
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162001367500000X
NVRN77203163W00000X
NVCRNA000436367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114989779Medicaid
NVV109062Medicare PIN
NV1114989779Medicaid
MANA007905Medicare PIN
NVV109061Medicare PIN