Provider Demographics
NPI:1235421017
Name:RUCKER, EHRAEDA FAITH-NOELLE (MA, QMHA)
Entity Type:Individual
Prefix:
First Name:EHRAEDA
Middle Name:FAITH-NOELLE
Last Name:RUCKER
Suffix:
Gender:F
Credentials:MA, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S HUALAPAI WAY APT 2128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8843
Mailing Address - Country:US
Mailing Address - Phone:702-306-5000
Mailing Address - Fax:
Practice Address - Street 1:2820 W CHARLESTON BLVD # C23
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner