Provider Demographics
NPI:1346399250
Name:COREY, TRACY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:COREY
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:PO BOX 47163
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7163
Mailing Address - Country:US
Mailing Address - Phone:206-819-4575
Mailing Address - Fax:206-762-0746
Practice Address - Street 1:8115 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2153
Practice Address - Country:US
Practice Address - Phone:206-763-2733
Practice Address - Fax:206-762-0746
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00095694163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9055575Medicaid