Individual
JOSEPH JOHN KUKUCKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
18 ASH CT, IRMO, SC 29063
(803) 749-9531
Mailing address
18 ASH CT, IRMO, SC 29063-9584
(803) 749-9531
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24211
SC
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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