Provider Demographics
NPI:1598084592
Name:LEBERT, TRACY JOY (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:JOY
Last Name:LEBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:NY
Mailing Address - Zip Code:13340-3509
Mailing Address - Country:US
Mailing Address - Phone:315-271-4892
Mailing Address - Fax:
Practice Address - Street 1:411 CANAL ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:NY
Practice Address - Zip Code:13340-3509
Practice Address - Country:US
Practice Address - Phone:315-271-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY621584-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse