Individual
MR. TODD WALLACE KACZMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
601 COLLIERS WAY, WEIRTON, WV 26062-5014
(304) 797-6000
Mailing address
601 COLLIERS WAY, WEIRTON, WV 26062-5014
(304) 797-6000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
74410
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
081278
PA
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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