Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043561178 |
---|---|
Provider Name | Janera Tucker |
First Address | Fallon, NV 89407-1240 |
Second Address | Fallon, NV 89406-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2012 |
Last Update Date | 28/09/2012 |