Healthcare Provider Details

I. General information

NPI: 1306040241
Provider Name (Legal Business Name): BRIANNE NICOLE CICCHIANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20000 HARVARD AVE
WARRENSVILLE HEIGHTS OH
44122-6805
US

IV. Provider business mailing address

8050 PRAIRIE XING
MACEDONIA OH
44056-2360
US

V. Phone/Fax

Practice location:
  • Phone: 216-491-6110
  • Fax:
Mailing address:
  • Phone: 330-748-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.009356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: