Provider Demographics
NPI:1497933394
Name:TEIPEN, TRACY M (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:M
Last Name:TEIPEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:LARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:550 N. UNIVERSITY BLVD. UH 1451
Mailing Address - Street 2:
Mailing Address - City:INDPLS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-278-1849
Mailing Address - Fax:
Practice Address - Street 1:550 N. UNIVERSITY BLVD. UH 1451
Practice Address - Street 2:
Practice Address - City:INDPLS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-278-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28143192A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse