Provider Demographics
NPI:1982811584
Name:STUCKEY, CYNTHIA ROSE (RN LACTATION CONSULT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ROSE
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:RN LACTATION CONSULT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 BREAKWATER DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5319
Mailing Address - Country:US
Mailing Address - Phone:757-483-0391
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-4775
Practice Address - Fax:757-953-0896
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001088301163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1986199357OtherRN LACTATION CONSULTANT