Provider Demographics
NPI:1720241292
Name:TUCKER, ADELE D (RN)
Entity type:Individual
Prefix:MS
First Name:ADELE
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9919 SOMERSET
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3413
Mailing Address - Country:US
Mailing Address - Phone:216-256-4031
Mailing Address - Fax:
Practice Address - Street 1:9919 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3413
Practice Address - Country:US
Practice Address - Phone:216-256-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 117774 MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse