Provider Demographics
NPI:1679920342
Name:FICCO, KATHY (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:FICCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 NOVATO BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2912
Mailing Address - Country:US
Mailing Address - Phone:415-897-6884
Mailing Address - Fax:415-897-1585
Practice Address - Street 1:1905 NOVATO BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2912
Practice Address - Country:US
Practice Address - Phone:415-897-6884
Practice Address - Fax:415-897-1585
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235931163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health