Provider Demographics
NPI:1154086759
Name:SHIMP, TRACI (RN, NC-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:SHIMP
Suffix:
Gender:F
Credentials:RN, NC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ASHBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2817
Mailing Address - Country:US
Mailing Address - Phone:609-217-8411
Mailing Address - Fax:
Practice Address - Street 1:16 ASHBROOKE DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2817
Practice Address - Country:US
Practice Address - Phone:609-217-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2610928900163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice