Provider Demographics
NPI:1245704295
Name:CRUICKSHANK, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CRUICKSHANK
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 1:53 LILAC DR APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3212
Mailing Address - Country:US
Mailing Address - Phone:516-717-9119
Mailing Address - Fax:
Practice Address - Street 1:53 LILAC DR APT 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3212
Practice Address - Country:US
Practice Address - Phone:516-717-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY748559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty