Healthcare Provider Details

I. General information

NPI: 1437242393
Provider Name (Legal Business Name): CAROL A TUCKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL A TUCKER MSN RN CDE APRN NP

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 340
LANSING MI
48912-1800
US

IV. Provider business mailing address

1200 E MICHIGAN AVE SUITE 340
LANSING MI
48912-1800
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5955
  • Fax: 517-364-5959
Mailing address:
  • Phone: 517-364-5955
  • Fax: 517-364-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704124272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: