Provider Demographics
NPI:1568851194
Name:NUCCIO, NICHOLAS JOSEPH (MSNA RN CRNA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:NUCCIO
Suffix:
Gender:M
Credentials:MSNA RN CRNA
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Mailing Address - Street 1:6346 W GIDDINGS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2932
Mailing Address - Country:US
Mailing Address - Phone:214-934-8192
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1174
Practice Address - Country:US
Practice Address - Phone:847-723-2210
Practice Address - Fax:847-723-3532
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX105461367500000X
IL209-017203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered