Individual
AMANDA MICHELLE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1500 SAN PABLO ST, LOS ANGELES, CA 90033-5313
(323) 442-7400
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-7400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2007019243
MO
367500000X
Certified Registered Nurse Anesthetist
2013017084
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
NA95000551
CA
Other
Enumeration date
04/06/2013
Last updated
09/09/2016
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