Provider Demographics
NPI:1346994407
Name:LEONATTI, TRACY LORENE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LORENE
Last Name:LEONATTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3723
Mailing Address - Country:US
Mailing Address - Phone:586-530-7647
Mailing Address - Fax:
Practice Address - Street 1:3521 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3723
Practice Address - Country:US
Practice Address - Phone:586-530-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider