Provider Demographics
NPI:1215189089
Name:LUNSFORD, TRACEY RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:RENEE
Last Name:LUNSFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 PROSPECT AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1566
Mailing Address - Country:US
Mailing Address - Phone:330-209-0000
Mailing Address - Fax:
Practice Address - Street 1:1131 PROSPECT AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1566
Practice Address - Country:US
Practice Address - Phone:330-209-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN126785 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse