Provider Demographics
NPI:1770587719
Name:TUCKER, PATRICIA LOU (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LOU
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PENNSYLVANIA AVE
Mailing Address - Street 2:1ST FLOOR / OTTUMA REGIONAL HEALTH CENTER
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6427
Mailing Address - Country:US
Mailing Address - Phone:641-684-2395
Mailing Address - Fax:615-684-2534
Practice Address - Street 1:MATERNAL AND WOMEN'S HEALTH
Practice Address - Street 2:1001 E PENNSYLVANIA AVE
Practice Address - City:OTTUMA
Practice Address - State:IA
Practice Address - Zip Code:52501-2195
Practice Address - Country:US
Practice Address - Phone:641-684-2395
Practice Address - Fax:615-684-2534
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF053221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0225607Medicaid
IA45584OtherWELLMARK
IA45584Medicare ID - Type Unspecified
IA0225607Medicaid