Provider Demographics
NPI:1083295430
Name:IACCO, NADINE MARGHERITE (RN)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:MARGHERITE
Last Name:IACCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 DEERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4134
Mailing Address - Country:US
Mailing Address - Phone:305-776-1787
Mailing Address - Fax:
Practice Address - Street 1:7196 DEERIDGE DR
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-4134
Practice Address - Country:US
Practice Address - Phone:305-776-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OHRN410143163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide