Provider Demographics
NPI:1497323513
Name:NIEMI, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:NIEMI
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 1:2404 COOLIDGE HWY APT 103
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3638
Mailing Address - Country:US
Mailing Address - Phone:906-553-1723
Mailing Address - Fax:
Practice Address - Street 1:2404 COOLIDGE HWY APT 103
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3638
Practice Address - Country:US
Practice Address - Phone:906-553-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703094140164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse