Individual
LARRY D. STUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-7838
(517) 205-5903
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704165719
MI
367500000X
Certified Registered Nurse Anesthetist
COA.02581-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0758309
—
OH
01
—
4704165719
MI LICENSE
MI
Enumeration date
02/10/2006
Last updated
01/26/2026
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