Provider Demographics
NPI:1700861754
Name:WICKELHAUS, CURTIS ALAN (CRNA)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:ALAN
Last Name:WICKELHAUS
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 1:401 E 20TH ST
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1583
Mailing Address - Country:US
Mailing Address - Phone:859-655-7160
Mailing Address - Fax:859-655-6742
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-572-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1046478163W00000X
KY038782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854606Medicaid
KY74105818Medicaid
000000537886OtherANTHEM
IN200878190Medicaid
9130426OtherPHCS
KY74105818Medicaid
0918135Medicare PIN
KY0969485Medicare PIN
9130426OtherPHCS