Provider Demographics
NPI:1073255634
Name:TUCK, PATTIE RAE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:PATTIE
Middle Name:RAE
Last Name:TUCK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 VIEW VISTA PARK
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9356
Mailing Address - Country:US
Mailing Address - Phone:360-565-4141
Mailing Address - Fax:
Practice Address - Street 1:325 E 6TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6203
Practice Address - Country:US
Practice Address - Phone:360-457-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00103617163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant