Provider Demographics
NPI:1235210733
Name:SADDLER, TRACEY DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:DIANE
Last Name:SADDLER
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 1:19 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2122
Mailing Address - Country:US
Mailing Address - Phone:757-595-4226
Mailing Address - Fax:
Practice Address - Street 1:19 WINSTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2122
Practice Address - Country:US
Practice Address - Phone:757-595-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002066434164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse