Provider Demographics
NPI:1669199857
Name:RUCKER, AYESHA CARMELITA
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:CARMELITA
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 1:12018 CHASE CROSSING CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4760
Mailing Address - Country:US
Mailing Address - Phone:202-423-0571
Mailing Address - Fax:
Practice Address - Street 1:3600 B ST SE APT 235
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7325
Practice Address - Country:US
Practice Address - Phone:202-678-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X3747A0650X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant