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General NPI Number Information
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NPI Number | 1932133618
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Entity Type | Individual
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Provider Name | PAUL KISUCKY III CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 925 S WALNUT ST
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City | LAS CRUCES
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State | NM
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Zip | 88001-3955
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Country | US
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Telephone | 575-523-6330
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W BOUTZ RD BLDG 1
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City | LAS CRUCES
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State | NM
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Zip | 88005-3259
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Country | US
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Telephone | 575-532-7033
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Fax | 575-556-7139
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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 | 583176
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License Number State | TX
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