Provider Demographics
NPI:1629614235
Name:PANTHI, SIMA
Entity Type:Individual
Prefix:MRS
First Name:SIMA
Middle Name:
Last Name:PANTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-5134
Mailing Address - Country:US
Mailing Address - Phone:608-792-6851
Mailing Address - Fax:
Practice Address - Street 1:343 SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-5134
Practice Address - Country:US
Practice Address - Phone:608-792-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI248926-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse