Provider Demographics
NPI:1932773611
Name:BUCCO, BREANNA M (APRN, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:M
Last Name:BUCCO
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 PROVIDENCE CT APT 207
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4033
Mailing Address - Country:US
Mailing Address - Phone:330-720-9558
Mailing Address - Fax:
Practice Address - Street 1:751 PROVIDENCE CT APT 207
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4033
Practice Address - Country:US
Practice Address - Phone:330-720-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.454443163W00000X
PARN713371163W00000X
NY807501163W00000X
PASP022093363LP0200X
OHAPRN.CNP.026102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty