Provider Demographics
NPI:1093853400
Name:KAPICHAK, JOSEPH R (ARNP, CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:KAPICHAK
Suffix:
Gender:M
Credentials:ARNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BROADWAY UNIT 320
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3778
Mailing Address - Country:US
Mailing Address - Phone:253-468-0049
Mailing Address - Fax:
Practice Address - Street 1:708 BROADWAY UNIT 320
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3778
Practice Address - Country:US
Practice Address - Phone:253-468-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00148522163W00000X
WAAP30006458363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4425080OtherMEDI-CAL
CAZZZ26897ZMedicare ID - Type Unspecified