Healthcare Provider Details

I. General information

NPI: 1588010292
Provider Name (Legal Business Name): GUZEL KUKINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FLUSHING AVE FL 2
BROOKLYN NY
11206-5026
US

IV. Provider business mailing address

2955 SHELL RD APT 10C
BROOKLYN NY
11224-3655
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax: 718-782-1538
Mailing address:
  • Phone: 718-313-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number711214
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: