Healthcare Provider Details

I. General information

NPI: 1003502253
Provider Name (Legal Business Name): RAISA CUCCIO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-2765
US

IV. Provider business mailing address

171 MAIN ST STE 203B
ASHLAND MA
01721-1187
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone: 508-881-3029
  • Fax: 508-881-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2304866
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2304866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: