Healthcare Provider Details

I. General information

NPI: 1992123921
Provider Name (Legal Business Name): DARCY CICCONETTI RNC, IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CANNON DR
WOOSTER OH
44691-8541
US

IV. Provider business mailing address

200 CANNON DR
WOOSTER OH
44691-8541
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-2319
  • Fax:
Mailing address:
  • Phone: 330-345-2319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN141529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: