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Individual

LASHYDREA RUCKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3136 NW 34TH ST, OKLAHOMA CITY, OK 73112-6720
(405) 651-4774
Mailing address
3136 NW 34TH ST, OKLAHOMA CITY, OK 73112-6720
(405) 651-4774

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200287120A
OK
Enumeration date
04/26/2013
Last updated
05/08/2013
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