Individual
MRS. LACHELLE MARIE CUCINELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
22806 LAKE BLVD, SAINT CLAIR SHORES, MI 48082-1753
(586) 899-8982
Mailing address
22806 LAKE BLVD, SAINT CLAIR SHORES, MI 48082-1753
(586) 899-8982
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704241003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C254488585792
DRIVER LICENSE
MI
01
—
C254488585792
DRIVERS LICENSE
—
Enumeration date
09/03/2021
Last updated
09/03/2021
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