Provider Demographics
NPI:1164656286
Name:MCMANAWAY, TRACY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:MCMANAWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61823 MCKINLEY ST
Mailing Address - Street 2:PO BOX 94
Mailing Address - City:KIPLING
Mailing Address - State:OH
Mailing Address - Zip Code:43750-0094
Mailing Address - Country:US
Mailing Address - Phone:740-255-0831
Mailing Address - Fax:
Practice Address - Street 1:61823 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:KIPLING
Practice Address - State:OH
Practice Address - Zip Code:43750-0094
Practice Address - Country:US
Practice Address - Phone:740-255-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN303180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse