Provider Demographics
NPI:1366014664
Name:PUCCINI, COLLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:PUCCINI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1205
Mailing Address - Country:US
Mailing Address - Phone:630-456-8598
Mailing Address - Fax:
Practice Address - Street 1:10400 W HIGGINS RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3703
Practice Address - Country:US
Practice Address - Phone:847-416-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.0234902086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery