Basic Information
| Provider Information | |||||||||
| NPI: | 1942388806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020191004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082540017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731190 | ||||||||
| FaxNumber: | 5084736251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.