Provider Demographics
NPI:1427395821
Name:TUCK, MEREDITH SQUIRES (RN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SQUIRES
Last Name:TUCK
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 1:1980 MAIN HWY
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-8363
Mailing Address - Country:US
Mailing Address - Phone:803-245-3043
Mailing Address - Fax:803-245-3051
Practice Address - Street 1:1980 MAIN HWY
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-8363
Practice Address - Country:US
Practice Address - Phone:803-245-3043
Practice Address - Fax:803-245-3051
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN.92945 R163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool