MEDICARE: MRS. KAREN SOUZA TUCKER RN

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
1	163WS0200X	School Registered Nurse	51376	SC

General Provider Information

NPI Number	:	1811331424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN SOUZA TUCKER RN

Provider Business Mailing Address
First Line	:	995 NANTAHALA DR
Second Line	:
City	:	CHESNEE
State	:	SC
Zip	:	29323-8653
Country	:	US
Telephone Number	:	864-706-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 HANGING ROCK RD
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-7407
Country	:	US
Telephone Number	:	864-578-2884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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