Provider Demographics
NPI:1659778942
Name:NIEMI, TRACY A (LPN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:A
Last Name:NIEMI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7862 CLINTON STREET ROAD
Mailing Address - Street 2:LOT 5
Mailing Address - City:BERGEN
Mailing Address - State:NY
Mailing Address - Zip Code:14416-9584
Mailing Address - Country:US
Mailing Address - Phone:585-734-5562
Mailing Address - Fax:
Practice Address - Street 1:7862 CLINTON STREET ROAD
Practice Address - Street 2:LOT 5
Practice Address - City:BERGEN
Practice Address - State:NY
Practice Address - Zip Code:14416
Practice Address - Country:US
Practice Address - Phone:585-734-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297479164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse