Provider Demographics
NPI:1003556655
Name:DEAN, TRACEY RANEE
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:RANEE
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2234
Mailing Address - Country:US
Mailing Address - Phone:854-444-1431
Mailing Address - Fax:
Practice Address - Street 1:521 4TH AVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2234
Practice Address - Country:US
Practice Address - Phone:854-444-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant