Provider Demographics
NPI:1639309479
Name:WAGONEKA, TRACEY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:WAGONEKA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 RAINSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6993
Mailing Address - Country:US
Mailing Address - Phone:214-693-7567
Mailing Address - Fax:
Practice Address - Street 1:702 RAINSVILLE DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6993
Practice Address - Country:US
Practice Address - Phone:214-693-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health