Provider Demographics
NPI:1740874213
Name:AUSTIN, TRACI LYNN
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:SIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1424 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1735
Mailing Address - Country:US
Mailing Address - Phone:231-215-1638
Mailing Address - Fax:
Practice Address - Street 1:1175 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2100
Practice Address - Country:US
Practice Address - Phone:231-220-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other