Individual
SIDRA E RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10910 N PENN AVE, OKLAHOMA CITY, OK 73120-7610
(405) 906-9338
Mailing address
10910 N PENN AVE, OKLAHOMA CITY, OK 73120-7610
(405) 906-9338
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
1744P3200X
Prosthetics Case Management
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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