Individual
DR. PENNIE ELIZABETH BUCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN CNP
Contact information
Practice address
1500 MCANDREWS RD W, BURNSVILLE, MN 55337
(952) 892-9393
(952) 800-8892
Mailing address
1500 MCANDREWS RD W, BURNSVILLE, MN 55337
(952) 892-9393
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R156407-9
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R156407-9 CNP1972
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104225499
MINNESOTA HEALTH CARE PROGRAMS (MHCP)
MN
Enumeration date
08/22/2014
Last updated
09/23/2020
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