Provider Demographics
NPI:1427715978
Name:TUCKER, CHEASLEA (IM A CNA)
Entity type:Individual
Prefix:MRS
First Name:CHEASLEA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:IM A CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:IA
Mailing Address - Zip Code:52050-8551
Mailing Address - Country:US
Mailing Address - Phone:563-920-5472
Mailing Address - Fax:
Practice Address - Street 1:116 S FRONT ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:IA
Practice Address - Zip Code:52050-8551
Practice Address - Country:US
Practice Address - Phone:563-920-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA277926376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide