Provider Demographics
NPI:1285245753
Name:KUCZKOWSKI, MICHELLE SUSAN (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUSAN
Last Name:KUCZKOWSKI
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:SUSAN
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13020 MOORCROFT LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7815
Mailing Address - Country:US
Mailing Address - Phone:920-948-3198
Mailing Address - Fax:
Practice Address - Street 1:6230 E. STASSNEY LANE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744
Practice Address - Country:US
Practice Address - Phone:920-948-3198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily