Provider Demographics
NPI:1336217983
Name:ZUKUS, CARL A (CRNA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:ZUKUS
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 1:100 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-6402
Mailing Address - Country:US
Mailing Address - Phone:570-278-3801
Mailing Address - Fax:570-278-3648
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-6402
Practice Address - Country:US
Practice Address - Phone:570-278-3801
Practice Address - Fax:570-278-3648
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN250630L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA023171Medicare PIN