Provider Demographics
NPI:1619646809
Name:WAYE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WAYE
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 1:1402 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3936
Mailing Address - Country:US
Mailing Address - Phone:989-577-9721
Mailing Address - Fax:
Practice Address - Street 1:1402 SPRING ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3936
Practice Address - Country:US
Practice Address - Phone:989-577-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
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