Provider Demographics
NPI:1285972737
Name:ZUCK, AMANDA RAYE (CRNA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAYE
Last Name:ZUCK
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E TONK ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5884
Mailing Address - Country:US
Mailing Address - Phone:307-670-2784
Mailing Address - Fax:
Practice Address - Street 1:3100 W LAKEWAY RD STE 3
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6373
Practice Address - Country:US
Practice Address - Phone:307-682-7819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31539367500000X
WY23443.1224367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered