Provider Demographics
NPI:1659518850
Name:DEMBOWSKI, TRACIE LYN (NP)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LYN
Last Name:DEMBOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 6 D
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-879-0393
Mailing Address - Fax:617-879-0838
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 6 D
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-879-0393
Practice Address - Fax:617-879-0838
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA196232363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner