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General NPI Number Information
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NPI Number | 1609732205
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Entity Type | Individual
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Provider Name | MICHELLE TUCKERMAN
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Gender | Female
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 11900 HUDSON RD
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City | PITTSFORD
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State | MI
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Zip | 49271-9657
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Country | US
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Telephone | 517-610-3925
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Fax |
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Provider Business Mailing Address
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Address Line | 11900 HUDSON RD
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City | PITTSFORD
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State | MI
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Zip | 49271-9657
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Country | US
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Telephone | 517-610-3925
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704223150
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License Number State | MI
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