Provider Demographics
NPI:1093018061
Name:STUCKEY, BENNEDICTA
Entity Type:Individual
Prefix:
First Name:BENNEDICTA
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4389
Mailing Address - Country:US
Mailing Address - Phone:859-420-8318
Mailing Address - Fax:
Practice Address - Street 1:2222 ALBEMARLE DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-4389
Practice Address - Country:US
Practice Address - Phone:859-420-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN141676164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse