Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | A01348 | AR |
NPI | 1023367752 |
---|---|
Provider Name | Ruthann Marie Tucker |
First Address | Eureka Springs, AR 72631-9080 |
Second Address | Eureka Springs, AR 72631-9080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 03/11/2014 |