Provider Demographics
NPI:1881486330
Name:FUCHILLA, DE ANNA NICHOLE
Entity type:Individual
Prefix:MRS
First Name:DE ANNA
Middle Name:NICHOLE
Last Name:FUCHILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 MCCLEARY JACOBY RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1718
Mailing Address - Country:US
Mailing Address - Phone:330-718-1499
Mailing Address - Fax:
Practice Address - Street 1:3176 MCCLEARY JACOBY RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1718
Practice Address - Country:US
Practice Address - Phone:330-718-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.372711163WM0705X
PARN801111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse