Provider Demographics
NPI:1356072516
Name:BURKHARD, TRACY LYN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYN
Last Name:BURKHARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14481-9646
Mailing Address - Country:US
Mailing Address - Phone:585-447-8398
Mailing Address - Fax:
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NY
Practice Address - Zip Code:14481-9646
Practice Address - Country:US
Practice Address - Phone:585-447-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse