Individual
ETHAN JOHN CHUPKA
Active
Individual
ETHAN JOHN CHUPKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704315820
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704315820
MI
367500000X
Certified Registered Nurse Anesthetist
APN.1000360-CRNA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704315820
MI LICENSE
MI
Enumeration date
10/27/2020
Last updated
08/17/2026
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