Healthcare Provider Details

I. General information

NPI: 1982811584
Provider Name (Legal Business Name): CYNTHIA ROSE STUCKEY RN LACTATION CONSULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

4036 BREAKWATER DR
PORTSMOUTH VA
23703-5319
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-4775
  • Fax: 757-953-0896
Mailing address:
  • Phone: 757-483-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001088301
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: