Healthcare Provider Details

I. General information

NPI: 1306852983
Provider Name (Legal Business Name): KRISTY ZIMMER ZUECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY J ZUECK CRNA

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD DEPARTMENT OF ANESTHESIA
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

2317 NORTHEASTER CT
ARNOLD MO
63010-2578
US

V. Phone/Fax

Practice location:
  • Phone: 636-386-7222
  • Fax:
Mailing address:
  • Phone: 636-296-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number151253
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: