Provider Demographics
NPI:1326148891
Name:LOPER, TRACY LEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:LOPER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 W CAPITOL DR APT 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1466
Mailing Address - Country:US
Mailing Address - Phone:414-455-3096
Mailing Address - Fax:414-455-3096
Practice Address - Street 1:9610 W. CAPITOL DRIVE
Practice Address - Street 2:APT 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2572
Practice Address - Country:US
Practice Address - Phone:414-455-3096
Practice Address - Fax:414-455-3096
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124925030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse