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NPI Code Detail

MEDICARE: LAURA A TUCKER NP

MEDICARE: LAURA A TUCKER NP
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
1363L00000XNurse Practitioner2582033WI

General Provider Information

NPI Number : 1902892243
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA A TUCKER NP
Provider Business Mailing Address
First Line : THE NEUROSCIENCE GROUP OF NE WI
Second Line : WEST PAVILION 2ND FLOOR, 130 SENCOND STREET
City : NEENAH
State : WI
Zip : 54956-2753
Country : US
Telephone Number : 920-725-9373
Fax Number : 920-720-7392
Provider Business Practice Location Address
First Line : WEST PAVILION 2 FLOOR
Second Line : 130 SECOND STREET
City : NEENAH
State : WI
Zip : 54956-2753
Country : US
Telephone Number : 920-725-9373
Fax Number : 920-720-7392
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 07/08/2007

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Directions to “ LAURA A TUCKER NP” Practice Location

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