MEDICARE: AMANDA RAYE ZUCK CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	23443.1224	WY
2	367500000X	Certified Registered Nurse Anesthetist	R31539	ND

General Provider Information

NPI Number	:	1285972737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RAYE ZUCK CRNA

Provider Business Mailing Address
First Line	:	212 E TONK ST
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-5884
Country	:	US
Telephone Number	:	307-670-2784
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 W LAKEWAY RD STE 3
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6373
Country	:	US
Telephone Number	:	307-682-7819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	09/24/2025

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Directions to “ AMANDA RAYE ZUCK CRNA” Practice Location

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