Provider Demographics
NPI:1831510312
Name:KUCUKSADIC, ESAT (RN)
Entity type:Individual
Prefix:MR
First Name:ESAT
Middle Name:
Last Name:KUCUKSADIC
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W HOLMES AVE UNIT 341
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5179
Mailing Address - Country:US
Mailing Address - Phone:602-561-5312
Mailing Address - Fax:
Practice Address - Street 1:461 W HOLMES AVE UNIT 341
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5179
Practice Address - Country:US
Practice Address - Phone:602-561-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN171487163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency