Provider Demographics
NPI:1225755184
Name:MUCCIO, KIMBERLY JO
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:MUCCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 MEANDER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2122
Mailing Address - Country:US
Mailing Address - Phone:330-406-6425
Mailing Address - Fax:
Practice Address - Street 1:6730 MEANDER DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2122
Practice Address - Country:US
Practice Address - Phone:330-406-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.464225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse