Provider Demographics
NPI:1275287138
Name:WOODROW, TRACEY LEE (RN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:WOODROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LEE
Other - Last Name:BROCIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:910 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2124
Mailing Address - Country:US
Mailing Address - Phone:803-536-4900
Mailing Address - Fax:803-536-4980
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-536-4900
Practice Address - Fax:803-536-4980
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse