Provider Demographics
NPI:1972119873
Name:TUCKER, ERIC (RD LDN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 WALLINGFORD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-7817
Mailing Address - Country:US
Mailing Address - Phone:770-403-4112
Mailing Address - Fax:
Practice Address - Street 1:2609 DISCOVERY DR STE 125
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1905
Practice Address - Country:US
Practice Address - Phone:770-403-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006231133NN1002X, 133VN1501X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics