Individual
PATRICIA ANN TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN IBCLC
Contact information
Practice address
4490 BONANZA DR NE, GRAND RAPIDS, MI 49525-6848
(616) 481-7563
Mailing address
4490 BONANZA DR NE, GRAND RAPIDS, MI 49525-6848
(616) 481-7563
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
660207
MI
174N00000X
Lactation Consultant (Non-RN)
Primary
L-35277
MI
Other
Enumeration date
04/24/2016
Last updated
04/24/2016
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