Provider Demographics
NPI:1912791625
Name:PUCCIO, BREANNA LYNNAE (RN)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LYNNAE
Last Name:PUCCIO
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:LYNNAE
Other - Last Name:CAPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11211 HILL CREST LN
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-8257
Mailing Address - Country:US
Mailing Address - Phone:224-539-7249
Mailing Address - Fax:
Practice Address - Street 1:11211 HILL CREST LN
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-8257
Practice Address - Country:US
Practice Address - Phone:224-539-7249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI108848030163W00000X
IL041496642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse