Healthcare Provider Details

I. General information

NPI: 1740991124
Provider Name (Legal Business Name): LAURIE CUCCIA MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1782
US

IV. Provider business mailing address

7064 WIL LOU LN
NORTH RIDGEVILLE OH
44039-3140
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 440-783-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN285066
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: