Provider Demographics
NPI:1336724368
Name:FORCUCCI, PHYLLIS ANN
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:FORCUCCI
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 1:8135 SNIDER LN
Mailing Address - Street 2:
Mailing Address - City:STONEWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26301-7741
Mailing Address - Country:US
Mailing Address - Phone:304-203-4873
Mailing Address - Fax:
Practice Address - Street 1:8135 SNIDER LN
Practice Address - Street 2:
Practice Address - City:STONEWOOD
Practice Address - State:WV
Practice Address - Zip Code:26301-7741
Practice Address - Country:US
Practice Address - Phone:304-203-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant