Provider Demographics
NPI:1366998775
Name:CUCCIO, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:CUCCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:SCHIRTZINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:3155 EAKIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1711
Mailing Address - Country:US
Mailing Address - Phone:614-980-6935
Mailing Address - Fax:
Practice Address - Street 1:3155 EAKIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1711
Practice Address - Country:US
Practice Address - Phone:614-980-6935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401460761112390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401460761112OtherOHIO NURSE AIDE REGISTRY
OHDD0007445OtherOHIO DODD