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General NPI Number Information
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NPI Number | 1497742977
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Entity Type | Individual
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Provider Name | ELISABETH DUNNING TUCKER MD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 500 CAMPUS DR
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City | HANCOCK
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State | MI
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Zip | 49930-1452
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Country | US
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Telephone | 906-483-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 7259 S BINGHAM JUNCTION BLVD
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City | MIDVALE
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State | UT
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Zip | 84047-4860
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Country | US
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Telephone | 800-453-3030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301111000
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD27445
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME52064
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License Number State | FL
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