Provider Demographics
NPI:1407326747
Name:KUEKER, TAMMY (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:KUEKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W FIELD DR
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-1304
Mailing Address - Country:US
Mailing Address - Phone:618-282-3858
Mailing Address - Fax:618-282-3965
Practice Address - Street 1:200 W FIELD DR
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1304
Practice Address - Country:US
Practice Address - Phone:618-282-3858
Practice Address - Fax:618-282-3965
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.278476163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse