| NPI | 1891809265 |
|---|---|
| Former Name | MARY TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VT 101.0105169) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3003032) |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3003032) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-09-13 |