Provider Demographics
NPI:1699515213
Name:RUCKER, MARLENA
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 N TEUTONIA AVE.
Mailing Address - Street 2:STE 135
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3646
Mailing Address - Country:US
Mailing Address - Phone:414-839-4484
Mailing Address - Fax:
Practice Address - Street 1:6111 N TEUTONIA AVE.
Practice Address - Street 2:STE 135
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3646
Practice Address - Country:US
Practice Address - Phone:414-839-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula