Healthcare Provider Details

I. General information

NPI: 1174079461
Provider Name (Legal Business Name): MYRNA MARCUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CASERMA EDERLE BLDG 2310
VICENZA ITALY
09630
IT

IV. Provider business mailing address

CMR 427 BOX 519
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 390444619000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: