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NPI Code Detail

MEDICARE: MRS. SHELIA EVETTE TUCKER MSW

MEDICARE: MRS. SHELIA EVETTE TUCKER MSW
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
11041C0700XClinical Social Worker6801092339MI

General Provider Information

NPI Number : 1134433329
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHELIA EVETTE TUCKER MSW
Provider Business Mailing Address
First Line : 2701 CIRCLE DR
Second Line :
City : FLINT
State : MI
Zip : 48507-1809
Country : US
Telephone Number : 810-516-8180
Fax Number :
Provider Business Practice Location Address
First Line : 8245 HOLLY RD STE 200
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-2483
Country : US
Telephone Number : 810-242-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2010
Last Update Date : 09/13/2022

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