Individual
GWENDOLYN RITA TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCA
Contact information
Practice address
206 WAGGONER, TOLEDO, OH 43612
(419) 964-7728
Mailing address
206 WAGGONER, TOLEDO, OH 43612
(419) 984-7728
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111545
—
OH
Enumeration date
01/04/2018
Last updated
07/21/2022
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