MEDICARE: EVELYN LUCILLE RUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1003491127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN LUCILLE RUCKER

Provider Business Mailing Address
First Line	:	805 52ND ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5512
Country	:	US
Telephone Number	:	202-525-2184
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 52ND ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5512
Country	:	US
Telephone Number	:	202-525-2184
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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Directions to “ EVELYN LUCILLE RUCKER ” Practice Location

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