Healthcare Provider Details

I. General information

NPI: 1841296365
Provider Name (Legal Business Name): RICHARD J. KUCERA APRN-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8823
  • Fax: 330-543-3593
Mailing address:
  • Phone: 330-543-8823
  • Fax: 330-543-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.07561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: