Provider Demographics
NPI:1689694937
Name:PANTER, STEPHEN D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:PANTER
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 3797
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3797
Mailing Address - Country:US
Mailing Address - Phone:775-883-2202
Mailing Address - Fax:775-883-0797
Practice Address - Street 1:313 WEST ANN STREET
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-883-2202
Practice Address - Fax:775-883-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV002367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2413300Medicaid
430000219OtherRAILROAD MEDICARE
NV2413300Medicaid