Individual
MS. PATRICIA ANN NUCKLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDEPENDENT PROVIDER
Contact information
Practice address
P.O. BOX 8411, CANTON, OH 44711
(330) 794-3295
Mailing address
P.O. BOX 8411, CANTON, OH 44711
(330) 794-3295
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0405694
—
OH
Enumeration date
07/03/2024
Last updated
07/03/2024
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