Provider Demographics
NPI:1699226910
Name:WHITE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 BEVERLY WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-5403
Mailing Address - Country:US
Mailing Address - Phone:276-806-6044
Mailing Address - Fax:276-336-8187
Practice Address - Street 1:717 BEVERLY WAY
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-5403
Practice Address - Country:US
Practice Address - Phone:276-806-6044
Practice Address - Fax:276-336-8187
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health