Individual
ADAM JEREMIAH KUZMIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3724 W ASHTON CT, ANTHEM, AZ 85086-2761
(623) 249-4207
Mailing address
3724 W ASHTON CT, ANTHEM, AZ 85086-2761
(623) 249-4207
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN127736
AZ
207L00000X
Anesthesiology Physician
CRNA0794
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA0794
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
664809
—
AZ
01
—
Z148617
MEDICARE PTAN
AZ
Enumeration date
09/22/2011
Last updated
11/21/2018
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