Provider Demographics
NPI:1417460460
Name:TRACY, SANDI BETH (RN)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:BETH
Last Name:TRACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 N HAYDEN CT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-3624
Mailing Address - Country:US
Mailing Address - Phone:262-242-0454
Mailing Address - Fax:
Practice Address - Street 1:10222 N HAYDEN CT
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3624
Practice Address - Country:US
Practice Address - Phone:262-242-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87825-30163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty