Provider Demographics
NPI:1841537412
Name:STUCKER, AUDREY JOANNA
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:JOANNA
Last Name:STUCKER
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 1:2406 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-3531
Mailing Address - Country:US
Mailing Address - Phone:903-413-2526
Mailing Address - Fax:903-454-9780
Practice Address - Street 1:2406 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-3531
Practice Address - Country:US
Practice Address - Phone:903-413-2526
Practice Address - Fax:903-454-9780
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife