Provider Demographics
NPI:1417295627
Name:PEOPLES, TRACIE Y (HHA)
Entity Type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:Y
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 W. STREET NORTH EAST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018
Mailing Address - Country:US
Mailing Address - Phone:240-640-5425
Mailing Address - Fax:
Practice Address - Street 1:1610 W. STREET NORTH EAST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:240-640-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide