Provider Demographics
NPI:1407347420
Name:MING, TRACY LEE (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:MING
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 1:38457 HOOD ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-7343
Mailing Address - Country:US
Mailing Address - Phone:503-803-9569
Mailing Address - Fax:
Practice Address - Street 1:14516 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-2142
Practice Address - Country:US
Practice Address - Phone:503-253-9041
Practice Address - Fax:503-254-2140
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091003362LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse