Provider Demographics
NPI:1306855176
Name:MUNCIE, TRACI SUE (LPN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:SUE
Last Name:MUNCIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:SUE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:711 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9001
Mailing Address - Country:US
Mailing Address - Phone:740-397-6797
Mailing Address - Fax:
Practice Address - Street 1:711 COURTLAND DR
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-9001
Practice Address - Country:US
Practice Address - Phone:740-397-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse