Provider Demographics
NPI:1376774125
Name:GATES, TRACIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:GATES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 SOLON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4129
Mailing Address - Country:US
Mailing Address - Phone:216-534-8754
Mailing Address - Fax:
Practice Address - Street 1:6730 SOLON BLVD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-4129
Practice Address - Country:US
Practice Address - Phone:216-534-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse