Provider Demographics
NPI:1013194448
Name:BOPP, TRACI M (RN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:BOPP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:BOPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:898 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1407
Mailing Address - Country:US
Mailing Address - Phone:317-883-5275
Mailing Address - Fax:317-882-1631
Practice Address - Street 1:898 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1407
Practice Address - Country:US
Practice Address - Phone:317-883-5275
Practice Address - Fax:317-882-1631
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28129411A163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN154024Medicare UPIN