Healthcare Provider Details

I. General information

NPI: 1285245753
Provider Name (Legal Business Name): MICHELLE SUSAN KUCZKOWSKI APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MICHELLE SUSAN PAULSON

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 E. STASSNEY LANE
AUSTIN TX
78744
US

IV. Provider business mailing address

13020 MOORCROFT LN
AUSTIN TX
78729-7815
US

V. Phone/Fax

Practice location:
  • Phone: 920-948-3198
  • Fax:
Mailing address:
  • Phone: 920-948-3198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP145340
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: