Provider Demographics
NPI:1750641064
Name:EIKEY, TRACIE LYNN
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:EIKEY
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 1:33612 TRADEPOST RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:CA
Mailing Address - Zip Code:93510-1441
Mailing Address - Country:US
Mailing Address - Phone:661-478-3059
Mailing Address - Fax:
Practice Address - Street 1:33612 TRADEPOST RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:CA
Practice Address - Zip Code:93510-1441
Practice Address - Country:US
Practice Address - Phone:661-478-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255706164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse