Provider Demographics
NPI:1225467434
Name:CICCIU, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CICCIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:E
Other - Last Name:CICCIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:70 MALTA AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1529
Mailing Address - Country:US
Mailing Address - Phone:518-884-7195
Mailing Address - Fax:518-884-7101
Practice Address - Street 1:300 WOOD RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2246
Practice Address - Country:US
Practice Address - Phone:518-884-7270
Practice Address - Fax:518-884-7268
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY368588163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool