Provider Demographics
NPI:1821336488
Name:NOLIN, TRACI E (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:E
Last Name:NOLIN
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 WATERS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-8005
Mailing Address - Country:US
Mailing Address - Phone:818-469-4815
Mailing Address - Fax:
Practice Address - Street 1:2300 N HERRITAGE ST STE C
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1652
Practice Address - Country:US
Practice Address - Phone:252-523-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1177237600000X
NC12508231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter