Healthcare Provider Details

I. General information

NPI: 1083295430
Provider Name (Legal Business Name): NADINE MARGHERITE IACCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7196 DEERIDGE DR
WALTON HILLS OH
44146-4134
US

IV. Provider business mailing address

7196 DEERIDGE DR
WALTON HILLS OH
44146-4134
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-1787
  • Fax:
Mailing address:
  • Phone: 305-776-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN410143
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: