Individual
KEISHA LEE TUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
3514 ALDIE CT, RALEIGH, NC 27610-6925
(919) 279-2920
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
180581
NC
Other
Enumeration date
05/10/2022
Last updated
05/10/2022
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