Provider Demographics
NPI:1558086686
Name:HOWARD, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HOWARD
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 1:142 DIANA LN W
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4208
Mailing Address - Country:US
Mailing Address - Phone:937-304-1420
Mailing Address - Fax:
Practice Address - Street 1:142 DIANA LN W
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4208
Practice Address - Country:US
Practice Address - Phone:937-304-1420
Practice Address - Fax:937-318-9995
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRV172104374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide