Healthcare Provider Details

I. General information

NPI: 1942545595
Provider Name (Legal Business Name): MARIA KUCHMA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 THYME DR
WEBSTER NY
14580-9483
US

IV. Provider business mailing address

477 THYME DR
WEBSTER NY
14580-9483
US

V. Phone/Fax

Practice location:
  • Phone: 585-216-9792
  • Fax:
Mailing address:
  • Phone: 585-216-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number645366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: