Provider Demographics
NPI:1619758125
Name:BUCO, RENEE ANTIONETTE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANTIONETTE
Last Name:BUCO
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 1:55399 ADAMIK LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43772-9746
Mailing Address - Country:US
Mailing Address - Phone:740-509-3526
Mailing Address - Fax:
Practice Address - Street 1:65347 LAKE RD LOT B
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8519
Practice Address - Country:US
Practice Address - Phone:740-801-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider