Provider Demographics
NPI:1598989725
Name:RUCKER, ANGELA MARIE
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:RUCKER
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 1:2424 STATE ROUTE 772
Mailing Address - Street 2:
Mailing Address - City:RARDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45671-9605
Mailing Address - Country:US
Mailing Address - Phone:740-493-3067
Mailing Address - Fax:
Practice Address - Street 1:2424 STATE ROUTE 772
Practice Address - Street 2:
Practice Address - City:RARDEN
Practice Address - State:OH
Practice Address - Zip Code:45671-9605
Practice Address - Country:US
Practice Address - Phone:740-493-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2299963OtherINDEPENDENT PROVIDER