Provider Demographics
NPI:1841842713
Name:STUCKER, LYRRA SUSZANNE (RN)
Entity type:Individual
Prefix:
First Name:LYRRA
Middle Name:SUSZANNE
Last Name:STUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYRRA
Other - Middle Name:SUSZANNE
Other - Last Name:BARRINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3050 ELAINE AVE
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2049
Mailing Address - Country:US
Mailing Address - Phone:573-718-0220
Mailing Address - Fax:
Practice Address - Street 1:1500 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3318
Practice Address - Country:US
Practice Address - Phone:573-686-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013045490163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice