Provider Demographics
NPI:1689986093
Name:ABRAMS, TRACIE A (LPN)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:A
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:A
Other - Last Name:FABUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2524 SOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-337-1117
Mailing Address - Fax:
Practice Address - Street 1:167 CLINTON CORNERS RD
Practice Address - Street 2:
Practice Address - City:SALT POINT
Practice Address - State:NY
Practice Address - Zip Code:12578
Practice Address - Country:US
Practice Address - Phone:845-266-3084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2686871164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse