Provider Demographics
NPI:1851450035
Name:TUCKER, MARIE MILLIREN (MPH, RD, CD)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:MILLIREN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MPH, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 SE VALLEY VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-4310
Mailing Address - Country:US
Mailing Address - Phone:360-628-1861
Mailing Address - Fax:
Practice Address - Street 1:91 SW CHEHALIS AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1934
Practice Address - Country:US
Practice Address - Phone:360-628-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60208971133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered