Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN.420.123 | OH |
NPI | 1073144796 |
---|---|
Provider Name | Amanda Brittany Tucker |
First Address | Cincinnati, OH 45227-3208 |
Second Address | Cincinnati, OH 45219-2906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2020 |
Last Update Date | 31/01/2020 |