Provider Demographics
NPI:1720669898
Name:KUSZKA, PATRYCJA (PA-C)
Entity Type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:
Last Name:KUSZKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28908 N NOBEL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5850
Mailing Address - Country:US
Mailing Address - Phone:602-799-8684
Mailing Address - Fax:
Practice Address - Street 1:1848 E THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8103
Practice Address - Country:US
Practice Address - Phone:602-456-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant