Provider Demographics
NPI:1699930727
Name:PANTON, IAN BENJAMIN (RN)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:BENJAMIN
Last Name:PANTON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:BENJAMIN
Other - Last Name:PANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:24802 OLIVE TREE LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6427
Mailing Address - Country:US
Mailing Address - Phone:321-848-5366
Mailing Address - Fax:
Practice Address - Street 1:24802 OLIVE TREE LN
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94024-6427
Practice Address - Country:US
Practice Address - Phone:321-848-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse