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Individual
SHALA DEANNE CLUCAS
Active
Individual
SHALA DEANNE CLUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
723566
TX
163W00000X
Registered Nurse
751989
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
88765
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287409103
—
TX
01
—
8331UG
BCBS
TX
Enumeration date
07/25/2011
Last updated
06/05/2018
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