Provider Demographics
NPI:1982110813
Name:STUCKY, MICHELLE GOMEZ (DNP, WHNP-BC, IBCLC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:GOMEZ
Last Name:STUCKY
Suffix:
Gender:F
Credentials:DNP, 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 1:51ST MEDICAL GROUP UNIT 2060
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96278-2060
Mailing Address - Country:US
Mailing Address - Phone:505-784-9245
Mailing Address - Fax:
Practice Address - Street 1:51ST MEDICAL GROUP UNIT 2060
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96278-2060
Practice Address - Country:US
Practice Address - Phone:315-784-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004911363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology