Provider Demographics
NPI:1578133088
Name:TUCKER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 WATERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ME
Mailing Address - Zip Code:04005-7336
Mailing Address - Country:US
Mailing Address - Phone:207-499-7622
Mailing Address - Fax:
Practice Address - Street 1:263 WATERHOUSE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ME
Practice Address - Zip Code:04005-7336
Practice Address - Country:US
Practice Address - Phone:207-499-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider