Provider Demographics
NPI:1336423128
Name:RUCKER, LEAH J (RD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:RUCKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W KNOX RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3016
Mailing Address - Country:US
Mailing Address - Phone:480-323-4917
Mailing Address - Fax:
Practice Address - Street 1:221 W KNOX RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3016
Practice Address - Country:US
Practice Address - Phone:480-323-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered