Provider Demographics
NPI:1639768138
Name:LHERISSON, TRACEY (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:LHERISSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3003
Mailing Address - Country:US
Mailing Address - Phone:718-768-8500
Mailing Address - Fax:718-832-2523
Practice Address - Street 1:522 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3003
Practice Address - Country:US
Practice Address - Phone:718-768-8500
Practice Address - Fax:718-832-2523
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421049-01363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty