Individual
NICOLLETTE LEIGH PAUKSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, RN, CRNA
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6122
(864) 560-6276
Mailing address
PO BOX 277723, ATLANTA, GA 30384-7723
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
078458
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1652
—
SC
01
—
P00846188
RAILROAD MEDICARE
SC
Enumeration date
01/08/2008
Last updated
10/14/2010
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