Provider Information for 1073199170
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GARNADETTE STUCKEY
Sex: Female
NPI: 1073199170
Last Updated: 2021-03-20
Certification Date: 2021-03-20
Certification Date: 2021-03-20
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1073199170 | ||||||||
| Enumeration Date | 2021-03-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1384 FOREST AVE CALUMET CITY, IL 60409-6046 United States Phone: 708-541-5596 | Fax: | ||||||||
| Primary Practice Address | 1384 FOREST AVE CALUMET CITY, IL 60409-6046 United States Phone: 708-541-5596 | Fax: | ||||||||
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