Provider Demographics
NPI:1477571719
Name:FONTANA, STEVEN C (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:FONTANA
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 1:220 DUNWOODY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8886
Mailing Address - Country:US
Mailing Address - Phone:870-972-0957
Mailing Address - Fax:
Practice Address - Street 1:220 DUNWOODY DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8886
Practice Address - Country:US
Practice Address - Phone:870-972-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCO1417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039039Medicaid
LAP00637215Medicare PIN
LA3A527C734Medicare PIN