Provider Demographics
NPI:1760869416
Name:SMITH-BIVINS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SMITH-BIVINS
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 1:392 PEARL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-903-3414
Mailing Address - Fax:
Practice Address - Street 1:392 PEARL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2210
Practice Address - Country:US
Practice Address - Phone:716-903-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22623028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse