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General NPI Number Information
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NPI Number | 1689444846
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Entity Type | Individual
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Provider Name | KATRENA TUCKER RMA
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Gender | Female
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 1034 RAMBLE RUN RD
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-1847
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Country | US
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Telephone | 443-804-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 10770 COLUMBIA PIKE STE 300
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City | SILVER SPRING
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State | MD
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Zip | 20901-4439
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Country | US
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Telephone | 443-804-0306
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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