Provider Demographics
NPI:1578232799
Name:LOONEY, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LOONEY
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 1:8 OSCAR LN
Mailing Address - Street 2:
Mailing Address - City:ELKVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:25071-6367
Mailing Address - Country:US
Mailing Address - Phone:304-982-9130
Mailing Address - Fax:
Practice Address - Street 1:20 BROOKS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2903
Practice Address - Country:US
Practice Address - Phone:304-766-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant