Healthcare Provider Details

I. General information

NPI: 1558088559
Provider Name (Legal Business Name): ZUKHRA KUCHIYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE 305
ENGLEWOOD OH
45415-1165
US

IV. Provider business mailing address

9000 N MAIN ST STE 305
ENGLEWOOD OH
45415-1165
US

V. Phone/Fax

Practice location:
  • Phone: 937-832-9322
  • Fax:
Mailing address:
  • Phone: 937-832-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0031419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: