Healthcare Provider Details

I. General information

NPI: 1285972737
Provider Name (Legal Business Name): AMANDA RAYE ZUCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W LAKEWAY RD STE 3
GILLETTE WY
82718-6373
US

IV. Provider business mailing address

212 E TONK ST
GILLETTE WY
82718-5884
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-7819
  • Fax:
Mailing address:
  • Phone: 307-670-2784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number23443.1224
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR31539
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: