Individual
LATRESE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9600 WYOMING, DETROIT, MI 48204
(313) 989-3411
Mailing address
3835 HOLCOMB ST, DETROIT, MI 48214-1386
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T260488139143
—
MI
Enumeration date
07/25/2019
Last updated
07/25/2019
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