Provider Demographics
NPI:1609217215
Name:STUCKLEN, RENEE IRENE (LAC, DIPL OM; LMT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:IRENE
Last Name:STUCKLEN
Suffix:
Gender:F
Credentials:LAC, DIPL OM; LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 E FORT LOWELL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1625
Mailing Address - Country:US
Mailing Address - Phone:831-428-9887
Mailing Address - Fax:
Practice Address - Street 1:3208 E FORT LOWELL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1625
Practice Address - Country:US
Practice Address - Phone:831-428-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist