Healthcare Provider Details

I. General information

NPI: 1366931644
Provider Name (Legal Business Name): IRENA KUCA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CORDATA PKWY STE 2C
BELLINGHAM WA
98226-7264
US

IV. Provider business mailing address

4010 AERIAL WAY
EUGENE OR
97402-9757
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5165
  • Fax: 360-752-5686
Mailing address:
  • Phone: 541-687-6353
  • Fax: 541-242-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD202354
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61560853
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: