Provider Demographics
NPI:1639189079
Name:BLOCK, PAULA KRUSE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:KRUSE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4350
Mailing Address - Country:US
Mailing Address - Phone:502-893-0658
Mailing Address - Fax:502-893-0658
Practice Address - Street 1:3404 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4350
Practice Address - Country:US
Practice Address - Phone:502-893-0658
Practice Address - Fax:502-893-0658
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1026608367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered