Healthcare Provider Details

I. General information

NPI: 1841117918
Provider Name (Legal Business Name): TUCKER MICHAEL WRAGE NREMT, CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SW 10TH ST STE 1
MADISON SD
57042-3200
US

IV. Provider business mailing address

303 NE 4TH ST
MADISON SD
57042-2213
US

V. Phone/Fax

Practice location:
  • Phone: 605-256-6551
  • Fax:
Mailing address:
  • Phone: 605-270-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE4148795
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: