Provider Demographics
NPI:1548739279
Name:TUCK, DIANA LYNN (QMHA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:TUCK
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1234
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-8234
Mailing Address - Country:US
Mailing Address - Phone:503-438-2229
Mailing Address - Fax:
Practice Address - Street 1:105 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2009
Practice Address - Country:US
Practice Address - Phone:503-397-6900
Practice Address - Fax:503-397-6818
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator