Provider Demographics
NPI:1861661233
Name:TUCKER, NANCY MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:TUCKER SAKAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:COOPER STATION
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10276
Mailing Address - Country:US
Mailing Address - Phone:212-673-2009
Mailing Address - Fax:212-673-2009
Practice Address - Street 1:300 EAST FIFTH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-673-2009
Practice Address - Fax:212-673-2009
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3432361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01380670Medicaid