Provider Demographics
NPI:1760248249
Name:TUCKERBUSH, EUREKA
Entity Type:Individual
Prefix:
First Name:EUREKA
Middle Name:
Last Name:TUCKERBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUREKA
Other - Middle Name:
Other - Last Name:TILLERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:667 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:667 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2963
Practice Address - Country:US
Practice Address - Phone:248-877-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider