Provider Demographics
NPI:1154631612
Name:LOUDON, TRACEY LEE (MN, RN, CNS, CCNS)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:LOUDON
Suffix:
Gender:F
Credentials:MN, RN, CNS, CCNS
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LEE
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32100 SE CHIN ST
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-9776
Mailing Address - Country:US
Mailing Address - Phone:503-663-0295
Mailing Address - Fax:
Practice Address - Street 1:32100 SE CHIN ST
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-9776
Practice Address - Country:US
Practice Address - Phone:503-663-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201070010CNS364S00000X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist