Provider Demographics
NPI:1952676918
Name:BUCZKO, RACHEL PAULINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:PAULINE
Last Name:BUCZKO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8564
Mailing Address - Country:US
Mailing Address - Phone:585-953-3433
Mailing Address - Fax:
Practice Address - Street 1:894 MEADOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8564
Practice Address - Country:US
Practice Address - Phone:585-953-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307632-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse