Provider Demographics
NPI:1265262695
Name:BUCK-HOOPER, TENNILLE OBVL (RN, BIRTH DOULA)
Entity type:Individual
Prefix:
First Name:TENNILLE
Middle Name:OBVL
Last Name:BUCK-HOOPER
Suffix:
Gender:F
Credentials:RN, BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-1120
Mailing Address - Country:US
Mailing Address - Phone:269-228-2030
Mailing Address - Fax:
Practice Address - Street 1:204 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-1120
Practice Address - Country:US
Practice Address - Phone:269-228-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula