Provider Demographics
NPI:1922514371
Name:SYMONS, TRACEY RAE (LPN)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:RAE
Last Name:SYMONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9621
Mailing Address - Country:US
Mailing Address - Phone:906-251-8228
Mailing Address - Fax:
Practice Address - Street 1:178 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9621
Practice Address - Country:US
Practice Address - Phone:906-251-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703095347164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse