Individual
MR. JERRY LAN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN
Contact information
Practice address
715 DR MARTIN LUTHER KING JR AVE NE STE 102, ALBUQUERQUE, NM 87102-3666
(505) 727-3028
Mailing address
8201 GOLF COURSE RD NW STE 183, ALBUQUERQUE, NM 87120-5842
(917) 334-2823
Taxonomy
Speciality
Code
Description
License number
State
133VN1301X
Oncology Nutrition Registered Dietitian
Primary
LD2023084
NM
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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