Provider Demographics
NPI:1619368214
Name:BROWAND, TRACEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:BROWAND
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 1:12229 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44235
Mailing Address - Country:US
Mailing Address - Phone:330-416-6953
Mailing Address - Fax:
Practice Address - Street 1:12219 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:OH
Practice Address - Zip Code:44235-9545
Practice Address - Country:US
Practice Address - Phone:330-416-6953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.137282-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse