Basic Information
| Provider Information | |||||||||
| NPI: | 1770983827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUCCIO | ||||||||
| FirstName: | REGINA | ||||||||
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| Credential: | M.S.-C.G.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 965 RIDGE LAKE BLVD | ||||||||
| Address2: | SUITE #103 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381209401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012273255 | ||||||||
| FaxNumber: | 9012278591 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 HUMPHREYS CENTER DR | ||||||||
| Address2: | SUITE #340 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012273255 | ||||||||
| FaxNumber: | 9012278591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2014 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | 50 | TN | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.