Provider Demographics
NPI:1508297623
Name:MAY, TRACY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:DESHLER
Mailing Address - State:OH
Mailing Address - Zip Code:43516-1151
Mailing Address - Country:US
Mailing Address - Phone:419-308-6408
Mailing Address - Fax:
Practice Address - Street 1:229 N VINE ST
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:OH
Practice Address - Zip Code:43516-1151
Practice Address - Country:US
Practice Address - Phone:419-308-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106285164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse