Provider Demographics
NPI:1477708097
Name:HUGHES, TRACI JEAN (RAS)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:JEAN
Last Name:HUGHES
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13009 GREENHORN RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8479
Mailing Address - Country:US
Mailing Address - Phone:530-885-1961
Mailing Address - Fax:530-885-0713
Practice Address - Street 1:11960 HERITAGE OAK PL
Practice Address - Street 2:15
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2401
Practice Address - Country:US
Practice Address - Phone:530-885-1961
Practice Address - Fax:530-885-0713
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH0005301352171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator