Individual
MRS. SANDRA IACUCCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
139 FAIRBANKS RD, CHURCHVILLE, NY 14428-9782
(585) 293-1800
Mailing address
16 RONNIE LN, NORTH CHILI, NY 14514-1109
(585) 594-8440
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
317135-1
NY
Other
Enumeration date
12/21/2011
Last updated
12/21/2011
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