Provider Demographics
NPI:1508116260
Name:ACHREM, TRACIE MARIE (MSN CNM)
Entity Type:Individual
Prefix:MISS
First Name:TRACIE
Middle Name:MARIE
Last Name:ACHREM
Suffix:
Gender:F
Credentials:MSN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30701 WOODWARD AVE STE S200
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5903
Mailing Address - Country:US
Mailing Address - Phone:248-584-7600
Mailing Address - Fax:248-584-7606
Practice Address - Street 1:30701 WOODWARD AVE STE S200
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-5903
Practice Address - Country:US
Practice Address - Phone:248-584-7600
Practice Address - Fax:248-584-7606
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190710367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife