Shirley Mae Struck, L.P.N.

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0002075401 Issued in VA

Practice address

3340 Woodburn Rd
Annandale, VA 22003-1202

Phone

(703) 207-7713

Fax

(703) 289-2764

NPI assigned

Nov 13, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairfax County, Virginia

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fairfax, VA
  • NPI 1154356244
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1780864207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 WOODBURN RD",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031202",
            "telephone_number": "703-207-7713",
            "fax_number": "703-289-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 WOODBURN RD",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031202",
            "telephone_number": "703-207-7713",
            "fax_number": "703-289-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STRUCK",
        "first_name": "SHIRLEY",
        "middle_name": "MAE",
        "credential": "L.P.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-13",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VA",
            "license": "0002075401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven R. Johnson, D.D.S. PC
• Dennise Lissa Stewart, DC
• Robin Estelle Stewart, M.A.
• Margaret Strickland, MD
• Elyse M Striker
• Wendy Strycula, CNS
• Lola Stubblefield, LPC
• Jee Young Suk
• Adlah Sukkar, M.D.
• Bernard Enoch Sumer

• Licensed Practical Nurse in Annandale, VA
• Providers in Annandale, VA by specialty
• Licensed Practical Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.