Provider Demographics
NPI:1275217036
Name:DOW, TRACI MARIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:DOW
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 COUNTY ROAD 700 N
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-4015
Mailing Address - Country:US
Mailing Address - Phone:217-246-6520
Mailing Address - Fax:
Practice Address - Street 1:738 COUNTY ROAD 700 N
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468-4015
Practice Address - Country:US
Practice Address - Phone:217-246-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322723163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant