Provider Demographics
NPI:1851009955
Name:WEBER, TRACY R (RN, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:R
Last Name:WEBER
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:R
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1415 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2333
Mailing Address - Country:US
Mailing Address - Phone:779-696-4396
Mailing Address - Fax:779-696-5404
Practice Address - Street 1:1415 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2333
Practice Address - Country:US
Practice Address - Phone:779-696-4396
Practice Address - Fax:779-696-5404
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-334222163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator