Provider Demographics
NPI:1912365693
Name:RAY, TRACI MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:MONIQUE
Last Name:RAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 OLD CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8341
Mailing Address - Country:US
Mailing Address - Phone:843-437-0674
Mailing Address - Fax:
Practice Address - Street 1:8409 OLD CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8341
Practice Address - Country:US
Practice Address - Phone:843-437-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR47932163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator