Provider Demographics
NPI:1922435619
Name:DICKEY, TRACEY (STNA)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:
Last Name:DICKEY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 GIBBS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704
Mailing Address - Country:US
Mailing Address - Phone:330-546-4231
Mailing Address - Fax:
Practice Address - Street 1:413 GIBBS AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1531
Practice Address - Country:US
Practice Address - Phone:330-546-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401401230612376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide