Provider Demographics
NPI:1376211144
Name:CHUCCI, KARISA NOELLE
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:NOELLE
Last Name:CHUCCI
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 1:138B COLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2502
Mailing Address - Country:US
Mailing Address - Phone:304-695-2548
Mailing Address - Fax:
Practice Address - Street 1:138B COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2502
Practice Address - Country:US
Practice Address - Phone:304-695-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide