Provider Demographics
NPI:1942203658
Name:PAUZAUSKIE, JOHN MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:PAUZAUSKIE
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 1:700 MARVIN HANCOCK DR
Mailing Address - Street 2:APT 5
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4756
Mailing Address - Country:US
Mailing Address - Phone:409-489-9686
Mailing Address - Fax:
Practice Address - Street 1:1275 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4935
Practice Address - Country:US
Practice Address - Phone:409-384-5461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709721367500000X
MO067454367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84586UOtherBCBSTX
TX8C9369Medicare PIN