Provider Demographics
NPI:1043570997
Name:TUCKER, AUGUSTA HAWA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AUGUSTA
Middle Name:HAWA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:AUGUSTA
Other - Middle Name:HAWA
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:6700 BELCREST RD
Mailing Address - Street 2:APT 321
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1398
Mailing Address - Country:US
Mailing Address - Phone:240-305-4234
Mailing Address - Fax:
Practice Address - Street 1:6700 BELCREST RD
Practice Address - Street 2:APT 321
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1398
Practice Address - Country:US
Practice Address - Phone:240-305-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP43064164W00000X
DCLPN1003906164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse