Provider Demographics
NPI:1174335178
Name:VANWINKLE, TUCKER LEA (ATC NREMT MS)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:LEA
Last Name:VANWINKLE
Suffix:
Gender:M
Credentials:ATC NREMT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-0009
Mailing Address - Country:US
Mailing Address - Phone:541-263-0924
Mailing Address - Fax:
Practice Address - Street 1:1000 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2001
Practice Address - Country:US
Practice Address - Phone:541-263-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
E3732185146N00000X, 146N00000X
20000575712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic