Provider Demographics
NPI:1912700477
Name:TUCKER, DAWN A (STNA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 EWING AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4068
Mailing Address - Country:US
Mailing Address - Phone:419-296-8344
Mailing Address - Fax:
Practice Address - Street 1:477 EWING AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4068
Practice Address - Country:US
Practice Address - Phone:419-296-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health