Provider Demographics
NPI:1205640778
Name:RUCKER, RACQUEL KRISTINA LEE
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:KRISTINA LEE
Last Name:RUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STATON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1752
Mailing Address - Country:US
Mailing Address - Phone:240-501-1101
Mailing Address - Fax:
Practice Address - Street 1:350 EASTERN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2833
Practice Address - Country:US
Practice Address - Phone:202-248-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator