Provider Demographics
NPI:1457584757
Name:PUCCINI, GISELA INGE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:GISELA
Middle Name:INGE
Last Name:PUCCINI
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 1:8050 BAMM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9133
Mailing Address - Country:US
Mailing Address - Phone:315-699-7354
Mailing Address - Fax:
Practice Address - Street 1:8050 BAMM HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-9133
Practice Address - Country:US
Practice Address - Phone:315-699-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270295-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse