Provider Demographics
NPI:1912286337
Name:NUCCIO, ANDREA C (REGISTERED PROFESSIO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:NUCCIO
Suffix:
Gender:F
Credentials:REGISTERED PROFESSIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WEXFORD PLACE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580
Mailing Address - Country:US
Mailing Address - Phone:585-899-0883
Mailing Address - Fax:
Practice Address - Street 1:185 WEXFORD PLACE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580
Practice Address - Country:US
Practice Address - Phone:585-899-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279936-1163WP0200X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics