Provider Demographics
NPI:1063169258
Name:HERWIG-TUCKER, GARY-CHRISTIAN RYAN
Entity type:Individual
Prefix:
First Name:GARY-CHRISTIAN
Middle Name:RYAN
Last Name:HERWIG-TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 VINCENT CT
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-1280
Mailing Address - Country:US
Mailing Address - Phone:810-986-0786
Mailing Address - Fax:
Practice Address - Street 1:504 N GRAND TRAVERSE ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2536
Practice Address - Country:US
Practice Address - Phone:810-487-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician