Provider Demographics
NPI:1336927177
Name:TUCHALSKI, LUISA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:TUCHALSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1201
Mailing Address - Country:US
Mailing Address - Phone:414-241-2082
Mailing Address - Fax:
Practice Address - Street 1:220 S WILCOX ST # 1201
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-9997
Practice Address - Country:US
Practice Address - Phone:414-241-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical