Provider Demographics
NPI:1639347974
Name:SCHLUCKEBIER, CYNTHIA DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:SCHLUCKEBIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:WIELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9520 BURKE RD
Mailing Address - Street 2:BURKE ALLERGY & ASTHMA CENTER
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-425-8616
Mailing Address - Fax:703-425-8743
Practice Address - Street 1:9520 BURKE RD
Practice Address - Street 2:BURKE ALLERGY & ASTHMA CENTER
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-8616
Practice Address - Fax:703-425-8743
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001099352163W00000X
CA343902163W00000X
VA0017001560363L00000X
DCRN64343363L00000X
VA0024099352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner