Healthcare Provider Details

I. General information

NPI: 1699280834
Provider Name (Legal Business Name): CHELSEA AMANDA KUCERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA AMANDA HAYES

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 RAFAEL RIVERA WAY
LAS VEGAS NV
89113-5393
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0070
  • Fax: 702-209-2064
Mailing address:
  • Phone: 702-878-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9308430
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9308430
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number829008
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: