Provider Demographics
NPI:1447408455
Name:HUNT, TRACEY (RN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:HUNT
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 1:250 WHITE BIRCH LANE
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842
Mailing Address - Country:US
Mailing Address - Phone:518-648-6141
Mailing Address - Fax:518-648-6143
Practice Address - Street 1:250 WHITE BIRCH LANE
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842
Practice Address - Country:US
Practice Address - Phone:518-648-6141
Practice Address - Fax:518-648-6143
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404983-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse