Provider Demographics
NPI:1295096840
Name:TUCKER, MARCELLA LOUISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:LOUISE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARCELLA
Other - Middle Name:LOUISE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7724 IRWIN RD
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2569
Mailing Address - Country:US
Mailing Address - Phone:816-737-3052
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-922-2705
Practice Address - Fax:816-922-4753
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040504164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse