Provider Demographics
NPI:1417385642
Name:SANDERS, TRACY ANN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:SANDERS
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 1:1415 TODD FARM DR
Mailing Address - Street 2:APT 4
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1720
Mailing Address - Country:US
Mailing Address - Phone:847-652-8093
Mailing Address - Fax:
Practice Address - Street 1:1415 TODD FARM DR
Practice Address - Street 2:APT 4
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1720
Practice Address - Country:US
Practice Address - Phone:847-652-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-3901521374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide