| NPI | 1801555776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BREANNA BUCCO Owner 330-720-9558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2021-12-08 |