Provider Demographics
NPI:1558812933
Name:BOIDE, TRACIE L (MA)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:L
Last Name:BOIDE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SCHAFFER AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08311
Mailing Address - Country:US
Mailing Address - Phone:856-369-5726
Mailing Address - Fax:
Practice Address - Street 1:52 SCHAFFER AVENUE
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08311
Practice Address - Country:US
Practice Address - Phone:856-369-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171WV0202XOther Service ProvidersContractorVehicle Modifications
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant