Provider Demographics
NPI:1700202025
Name:HEINECKE, TRACY (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:HEINECKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 NW WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-5832
Mailing Address - Country:US
Mailing Address - Phone:513-896-3400
Mailing Address - Fax:
Practice Address - Street 1:2260 NW WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-5832
Practice Address - Country:US
Practice Address - Phone:513-896-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.270440163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool