Provider Demographics
NPI:1003052879
Name:RUCKER, JANICE M (CPCT, STNA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:RUCKER
Suffix:
Gender:F
Credentials:CPCT, STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 PATTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8743
Mailing Address - Country:US
Mailing Address - Phone:740-772-4187
Mailing Address - Fax:
Practice Address - Street 1:2020 PATTON HILL RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8743
Practice Address - Country:US
Practice Address - Phone:740-772-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2377-06403747P1801X
OH4008482612083747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant