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NPI Code Detail

MEDICARE: BENJAMIN TUCKER

MEDICARE: BENJAMIN TUCKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist28245419AIN

General Provider Information

NPI Number : 1710845698
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN TUCKER
Provider Business Mailing Address
First Line : 629 BROOKSIDE LN
Second Line :
City : PLAINFIELD
State : IN
Zip : 46168-2109
Country : US
Telephone Number : 317-625-5938
Fax Number :
Provider Business Practice Location Address
First Line : 1000 E MAIN ST
Second Line :
City : DANVILLE
State : IN
Zip : 46122-1948
Country : US
Telephone Number : 317-625-5938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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Directions to “ BENJAMIN TUCKER ” Practice Location

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