Provider Demographics
NPI:1275063620
Name:KIKUCHI, JEANNETTE LYNN (CO)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:LYNN
Last Name:KIKUCHI
Suffix:
Gender:F
Credentials:CO
Other - Prefix:MS
Other - First Name:JEANNETTE
Other - Middle Name:LYNN
Other - Last Name:GUARRIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:3955 BIGELOW BLVD APT 905
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1238
Mailing Address - Country:US
Mailing Address - Phone:301-580-0510
Mailing Address - Fax:
Practice Address - Street 1:300 ALPHA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2908
Practice Address - Country:US
Practice Address - Phone:412-477-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOH000308222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist