Provider Demographics
NPI:1982110813
Name:STUCKY, MICHELLE GOMEZ (MSN, WHNP-BC, IBCLC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GOMEZ
Last Name:STUCKY
Suffix:
Gender:F
Credentials:MSN, WHNP-BC, IBCLC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:SERRATA
Other - Last Name:STUCKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 COMMANDO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28307-1532
Mailing Address - Country:US
Mailing Address - Phone:254-338-8084
Mailing Address - Fax:
Practice Address - Street 1:1235 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4401
Practice Address - Country:US
Practice Address - Phone:910-433-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010112363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health