Provider Demographics
NPI:1699388140
Name:YONEY, TRACI LYNN
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:YONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:DEVILBISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:353 TRUMP ST
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9306
Mailing Address - Country:US
Mailing Address - Phone:304-410-4914
Mailing Address - Fax:
Practice Address - Street 1:353 TRUMP ST # SY
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9306
Practice Address - Country:US
Practice Address - Phone:304-410-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVE844839374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide