Provider Demographics
NPI:1790323061
Name:WALLS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WALLS
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 1:1978 NELAWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2214
Mailing Address - Country:US
Mailing Address - Phone:216-338-8486
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 314
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1095
Practice Address - Country:US
Practice Address - Phone:216-441-9622
Practice Address - Fax:888-460-4717
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide