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General NPI Number Information
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NPI Number | 1285972737
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Entity Type | Individual
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Provider Name | AMANDA RAYE ZUCK CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3100 W LAKEWAY RD STE 3
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City | GILLETTE
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State | WY
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Zip | 82718-6373
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Country | US
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Telephone | 307-682-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 212 E TONK ST
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City | GILLETTE
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State | WY
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Zip | 82718-5884
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Country | US
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Telephone | 307-670-2784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 23443.1224
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R31539
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License Number State | ND
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