Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003151739 |
---|---|
Provider Name | Ms. Niina Irene Tucker |
First Address | Lawton, OK 73505-5977 |
Second Address | Lawton, OK 73505-5977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 06/12/2012 |