Individual
TERESA WALLACE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2659 PIPER HILLS DR, BELLEVILLE, IL 62221-3458
(757) 561-8878
Mailing address
2659 PIPER HILLS DR, BELLEVILLE, IL 62221-3458
(757) 561-8878
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2014032763
MO
Other
Enumeration date
11/24/2014
Last updated
11/24/2014
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