Organization
PAUL KISUCKY CRNA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL KISUCKY CRNA (OWNER)
(682) 365-7402
Entity
Organization
Contact information
Practice address
1416 GEORGE DIETER DR, EL PASO, TX 79936-7601
(915) 252-1654
Mailing address
PO BOX 220717, EL PASO, TX 79913-2717
(682) 365-7402
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C05V
BLUE CROSS BLUE SHIELD
—
05
—
088570902
—
TX
01
—
2277986
AETNA
—
Enumeration date
11/09/2006
Last updated
11/15/2013
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