Physician Compare National (NPI:1104225499)

HEALTHCARE PROVIDER: PENNIE ELIZABETH BUCILLA APRN CNP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1104225499
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971814245
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150612002432
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUCILLA
	Individual professional last name
Provider First Name	PENNIE
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1601 SOUTHCROSS DR W
	Group Practice or individual's line 1 address
Line 2 Street Address	LOWR LEVEL
	Group Practice or individual's line 2 address
City	BURNSVILLE
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	553067020
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y