Organization
PAUL KISUCKY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL J KISUCKY III CRNA (OWNER)
(915) 301-5091
Entity
Organization
Contact information
Practice address
925 S WALNUT ST, LAS CRUCES, NM 88001-3955
(575) 523-6330
Mailing address
205 W BOUTZ RD BLDG 1, LAS CRUCES, NM 88005-3259
(575) 532-7033
(575) 556-7139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
05/03/2019
Last updated
05/03/2019
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