Provider Demographics
NPI:1073029690
Name:ADAMCZYK, TRACI ELLEN
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ELLEN
Last Name:ADAMCZYK
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 1:43701 SAINT JULIAN CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1804
Mailing Address - Country:US
Mailing Address - Phone:586-292-3806
Mailing Address - Fax:586-726-2472
Practice Address - Street 1:43701 SAINT JULIAN CT
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1804
Practice Address - Country:US
Practice Address - Phone:586-292-3806
Practice Address - Fax:586-726-2472
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse