Provider Demographics
NPI:1235590332
Name:RUCKER-MUHAMMAD, CAMEASHA
Entity Type:Individual
Prefix:
First Name:CAMEASHA
Middle Name:
Last Name:RUCKER-MUHAMMAD
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 1:1214 GRISWOLD ST
Mailing Address - Street 2:APT. 203
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1821
Mailing Address - Country:US
Mailing Address - Phone:313-695-8835
Mailing Address - Fax:
Practice Address - Street 1:1214 GRISWOLD ST
Practice Address - Street 2:APT. 203
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1821
Practice Address - Country:US
Practice Address - Phone:313-695-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other