MEDICARE: MRS. ANETHA LYNN MCDONALD-RUCKER

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	372500000X	Chore Provider
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1902430234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANETHA LYNN MCDONALD-RUCKER

Provider Business Mailing Address
First Line	:	8215 ORCHARD AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2932
Country	:	US
Telephone Number	:	248-229-6988
Fax Number	:

Provider Business Practice Location Address
First Line	:	8215 ORCHARD AVE
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-2932
Country	:	US
Telephone Number	:	248-229-6988
Fax Number	:

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

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	02/25/2020

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