Provider Demographics
NPI:1871710459
Name:TUCK, WENDY G (HOME HEALTH AIDE)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:G
Last Name:TUCK
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 BRANDT PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4308
Mailing Address - Country:US
Mailing Address - Phone:937-718-7132
Mailing Address - Fax:937-667-5399
Practice Address - Street 1:5802 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4308
Practice Address - Country:US
Practice Address - Phone:937-718-7132
Practice Address - Fax:937-667-5399
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2717493374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2717493Medicaid