Provider Demographics
NPI:1326365396
Name:TUCKER, BARBARA J (LPN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 US RT 11 183
Mailing Address - Street 2:NUMBER 183
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036
Mailing Address - Country:US
Mailing Address - Phone:315-668-3191
Mailing Address - Fax:
Practice Address - Street 1:852 US ROUTE 11 LOT 183
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9641
Practice Address - Country:US
Practice Address - Phone:315-668-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283770-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse