Individual
KENESHA LA'SHA RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5749 TROY VILLA BLVD, DAYTON, OH 45424-2647
(405) 821-1103
Mailing address
PO BOX 341153, BEAVERCREEK, OH 45434-1153
(405) 821-1103
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
323690820817
OH
Other
Enumeration date
11/12/2021
Last updated
11/12/2021
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