Individual
NIKITA DERYABIN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
PSC BOX 20183, CAMP LEJEUNE, NC 28542-0183
(910) 440-7704
Mailing address
PSC BOX 20183, CAMP LEJEUNE, NC 28542
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
12222246ND
NC
Other
Enumeration date
09/18/2024
Last updated
09/18/2024
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