Provider Demographics
NPI:1093457780
Name:LAFONTANT, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:LAFONTANT
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 1:6039 7TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2135
Mailing Address - Country:US
Mailing Address - Phone:206-276-7667
Mailing Address - Fax:
Practice Address - Street 1:6039 7TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2135
Practice Address - Country:US
Practice Address - Phone:206-276-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant