Healthcare Provider Details

I. General information

NPI: 1316139934
Provider Name (Legal Business Name): NICOLINA BUCCA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 WINDSOR WAY
BROADVIEW HTS OH
44147-1796
US

IV. Provider business mailing address

8605 WINDSOR WAY
BROADVIEW HTS OH
44147-1796
US

V. Phone/Fax

Practice location:
  • Phone: 440-582-1950
  • Fax:
Mailing address:
  • Phone: 440-582-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN204530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: