Provider Demographics
NPI:1588416820
Name:TUCKER, CHELA RENAY
Entity type:Individual
Prefix:
First Name:CHELA
Middle Name:RENAY
Last Name:TUCKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 MEGAN CIR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-4383
Mailing Address - Country:US
Mailing Address - Phone:330-282-7900
Mailing Address - Fax:
Practice Address - Street 1:2966 MEGAN CIR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4383
Practice Address - Country:US
Practice Address - Phone:330-282-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide