Provider Demographics
NPI:1033468194
Name:TUCKER, MARCIA ELAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ELAINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S EDGEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3230
Mailing Address - Country:US
Mailing Address - Phone:330-942-1661
Mailing Address - Fax:
Practice Address - Street 1:44 S EDGEHILL AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3230
Practice Address - Country:US
Practice Address - Phone:330-942-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 109089164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse