Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | RN61810 | DC |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0024165377 | VA |
NPI | 1104801844 |
---|---|
Provider Name | Theresa Harrington Stukus |
First Address | Fairfax, VA 22031-5218 |
Second Address | Fairfax, VA 22031-5218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00678664 | RAILROAD MEDICARE (01) | DC |
Q47431 | (02) |