Provider Demographics
NPI:1538512140
Name:TUCK, WAYNE NOLAN (LHIS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:NOLAN
Last Name:TUCK
Suffix:
Gender:M
Credentials:LHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 MONTGOMERY HWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3633
Mailing Address - Country:US
Mailing Address - Phone:205-824-8170
Mailing Address - Fax:
Practice Address - Street 1:1491 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3633
Practice Address - Country:US
Practice Address - Phone:205-824-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2179237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist