Provider Demographics
NPI:1578835666
Name:PANARESE, JONATHAN LOUIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LOUIS
Last Name:PANARESE
Suffix:
Gender:M
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 1:1000 AMERICAN PACIFIC DR
Mailing Address - Street 2:APT. 2621
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8790
Mailing Address - Country:US
Mailing Address - Phone:617-840-7549
Mailing Address - Fax:
Practice Address - Street 1:1000 AMERICAN PACIFIC DR
Practice Address - Street 2:APT. 2621
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8790
Practice Address - Country:US
Practice Address - Phone:617-840-7549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant