Provider Demographics
NPI:1356830756
Name:BUCILLA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BUCILLA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BUCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNP
Authorized Official - Phone:952-892-9393
Mailing Address - Street 1:1500 MCANDREWS RD W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE MN
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-892-9393
Mailing Address - Fax:952-892-9395
Practice Address - Street 1:1500 MCANDREWS RD W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE MN
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-892-9393
Practice Address - Fax:952-892-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR156407-9363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty