Provider Demographics
NPI:1568856789
Name:TUCKER, AMANDA DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DAWN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:DAWN
Other - Last Name:TUCKER-MEUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5053 RANGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-3536
Mailing Address - Country:US
Mailing Address - Phone:970-456-5245
Mailing Address - Fax:
Practice Address - Street 1:5053 RANGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-3536
Practice Address - Country:US
Practice Address - Phone:970-456-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology