Provider Demographics
NPI:1235106485
Name:BUCY, NANCI JAYNE (DO)
Entity Type:Individual
Prefix:
First Name:NANCI
Middle Name:JAYNE
Last Name:BUCY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 EDGEWATER POINTE, STE: 200
Mailing Address - Street 2:
Mailing Address - City:LAKE ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-561-8088
Mailing Address - Fax:636-561-1405
Practice Address - Street 1:1000 EDGEWATER POINTE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:636-561-8088
Practice Address - Fax:636-561-1405
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6N47207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO247819600Medicaid
003011541Medicare ID - Type Unspecified
F05536Medicare UPIN