Provider Demographics
NPI:1518763952
Name:RUCKER, CANDACE LATRICE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LATRICE
Last Name:RUCKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6562 CHEVIOT RD
Mailing Address - Street 2:APT 10
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-394-2639
Mailing Address - Fax:
Practice Address - Street 1:6562 CHEVIOT RD
Practice Address - Street 2:APT 10
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247
Practice Address - Country:US
Practice Address - Phone:513-394-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide