Provider Demographics
NPI:1407085608
Name:TUCKER, KAREN DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DENISE
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 1:9040D N 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-6853
Mailing Address - Country:US
Mailing Address - Phone:414-551-2317
Mailing Address - Fax:
Practice Address - Street 1:9040D N 95TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-6853
Practice Address - Country:US
Practice Address - Phone:414-551-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304161-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse