Provider Demographics
NPI:1154321511
Name:KACHUR, NICHOLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:KACHUR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1146
Mailing Address - Country:US
Mailing Address - Phone:570-970-1030
Mailing Address - Fax:570-270-0577
Practice Address - Street 1:11 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1146
Practice Address - Country:US
Practice Address - Phone:570-970-1030
Practice Address - Fax:570-270-0577
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016467367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN152998LOtherRN STATE LICENSE