Basic Information
| Provider Information | |||||||||
| NPI: | 1902139736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUCK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 411895 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641411895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136322230 | ||||||||
| FaxNumber: | 9136322297 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136322230 | ||||||||
| FaxNumber: | 9136322297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1497231021 | KS | N | Nursing Service Providers | Registered Nurse | 367500000X | 556907 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 43093015 | 01 | KS | BCBS KC | OTHER | 1902139736 | 05 | MO | MEDICAID | 200621370A | 05 | KS | MEDICAID | P00765513 | 01 | KS | RR MEDICARE | OTHER |