Provider Demographics
NPI:1629859244
Name:TUTSON, RYKELL NICKEYA
Entity Type:Individual
Prefix:
First Name:RYKELL
Middle Name:NICKEYA
Last Name:TUTSON
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 1:25792 IRIS AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2970
Mailing Address - Country:US
Mailing Address - Phone:951-347-5417
Mailing Address - Fax:
Practice Address - Street 1:25792 IRIS AVE UNIT B
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-2970
Practice Address - Country:US
Practice Address - Phone:951-347-5417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95103246163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse