Healthcare Provider Details

I. General information

NPI: 1932623865
Provider Name (Legal Business Name): DAVID P KUCMANIC CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 EUCLID AVE
WILLOUGHBY OH
44094-4625
US

IV. Provider business mailing address

7757 AUBURN RD STE 15
PAINESVILLE OH
44077-9604
US

V. Phone/Fax

Practice location:
  • Phone: 440-350-0832
  • Fax: 440-579-0191
Mailing address:
  • Phone: 440-350-0832
  • Fax: 440-354-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: