Provider Demographics
NPI:1689444846
Name:TUCKER, KATRENA (RMA)
Entity Type:Individual
Prefix:
First Name:KATRENA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 COLUMBIA PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4439
Mailing Address - Country:US
Mailing Address - Phone:443-804-0306
Mailing Address - Fax:
Practice Address - Street 1:1034 RAMBLE RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1847
Practice Address - Country:US
Practice Address - Phone:443-804-0306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory