Provider Demographics
NPI:1760873582
Name:RUCKER, ANGIE (RHIA)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:RHIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 MAIN STREET SUITE C
Mailing Address - Street 2:BOX #109
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-955-9434
Mailing Address - Fax:601-510-7791
Practice Address - Street 1:1888 MAIN ST STE C
Practice Address - Street 2:BOX #109
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6337
Practice Address - Country:US
Practice Address - Phone:601-955-9434
Practice Address - Fax:601-510-7791
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker