Provider Demographics
NPI:1760126510
Name:KUCZYNSKI, ELIZABETH MARIA (CNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARIA
Last Name:KUCZYNSKI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7455 N SHORE CIR N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8710
Mailing Address - Country:US
Mailing Address - Phone:443-794-2549
Mailing Address - Fax:
Practice Address - Street 1:5320 W 23RD ST STE 130
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1670
Practice Address - Country:US
Practice Address - Phone:952-345-3213
Practice Address - Fax:884-593-1082
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN9133363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health