Healthcare Provider Details

I. General information

NPI: 1386788511
Provider Name (Legal Business Name): RUTH TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH NICHOLS RN

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 26TH AVE
OAKLAND CA
94601-1907
US

IV. Provider business mailing address

3757 39TH AVE APT 3
OAKLAND CA
94619-2039
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-2363
  • Fax: 510-437-2366
Mailing address:
  • Phone: 510-531-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number484519
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number484519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: