Provider Demographics
NPI:1033844410
Name:WHETSEL RUCKER, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:WHETSEL RUCKER
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 1:564 W ROCK RD
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-4047
Mailing Address - Country:US
Mailing Address - Phone:540-320-5660
Mailing Address - Fax:
Practice Address - Street 1:564 W ROCK RD
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-4047
Practice Address - Country:US
Practice Address - Phone:540-320-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula